Fenestrated wound repair scaffold

ABSTRACT

Fenestrated wound repair scaffolds and methods for forming scaffolds involve dispersing human collagen having a preserved amount of native constituents in solution, depositing the human collagen dispersion in a tray, forming openings in the collagen dispersion and removing the liquid component to form a fenestrated wound repair scaffold. Fenestrated wound repair scaffolds include a network of openings passing linearly through the wound repair scaffold to form channels for cells to pass into so as to form a series of cell formations therein.

FIELD OF THE INVENTION

The invention relates generally to a method for preparing human-derivedcollagen fiber and/or thread base materials and collagen implants usingthe collagen fiber and/or thread base materials.

BACKGROUND

Collagen is used as an implant material to replace or augment hard orsoft connective tissue, such as skin, tendons, cartilage, and bone. Someimplants are formed as solid, flexible, or deformable collagen massescross-linked with chemical agents, radiation, or other means to improvemechanical properties, decrease the chance of an immunogenic response,and/or to manage the resorption rate, or to improve the mechanicalproperties.

Collagen-based medical implants for use in humans generally have been ofa non-human origin, i.e., xenogenic. A problem with the use of xenogenictissue as a starting material when generating medical implants is thatthe tissue may be contaminated with viruses or prions. For example,products using bovine sourced tissue have the potential for transmittingBSE (Bovine Spongiform Encephalopathy).

Another problem with the use of xenogenic tissue is the potential forinflammation responses, hematomas, adhesions, and rejection afterimplantation. This is because xenogenic collagen and telopeptides caninclude antigens and other constituents that can initiate an immunogenicresponse in humans. Additionally, a certain proportion of patients candevelop allergic reactions to implanted xenogeneic materials.

Thus, there is a need for methods to isolate collagen fiber and/orthread base materials for products made from the collagen fiber and/orthread base materials that are less likely to produce an immunogenicresponse.

SUMMARY

Various embodiments of the invention address the issues described aboveby providing collagen-based medical implants suitable for implantationinto humans that are derived from human or human-like collagen. Thecollagen-based medical implants may include one or more of thefollowing: growth factors and other non-collagenous proteins, a lowimmunogenicity, and desirable handling properties.

In some embodiments collagen implants may be formed from collagenproducts having a preserved amount of native human or human-likeconstituents. Such collagen products may include collagen fiber,fibrillar collagen, microfibrillar collagen, particulate collagen,collagen thread, intermediate collagen products that may or may notcontain alcohol, and that may or may not be derived from a foamcontaining collagen and a leveling agent. Collagen implants may includecollagen films, collagen coatings, collagen strands, fibers, filaments,threads and fabrics produced therefrom, foam-formed threads and fabricsproduced therefrom, injectable collagen, collagen tubes, collagen plugs,collagen for in vitro applications, collagen scaffolds, fenestratedcollagen scaffolds, and combinations and variations thereof. In variousembodiments, fenestrated scaffolds refer to channels that passcompletely through the scaffold, and/or channels that pass into, but notcompletely through, the scaffold.

In one embodiment, a method for forming a medical implant includesblending a dispersion of human or human-like collagen product fiberand/or thread base materials and a volume between about 2% to about 15%of an alcohol having a purity of about 70% to about 99.999%;reconstituting a foam component of the blended collagen productdispersion into a liquid phase; and removing the liquid component of thereconstituted collagen product dispersion.

In another embodiment, a method for forming a medical implant includesremoving a liquid component from an intermediate collagen product toform collagen products including: collagen films, collagen coatings,collagen strands, fibers, filaments, threads and fabrics producedtherefrom, collagen tubes, collagen plugs, collagen scaffolds, andcollagen products for injection and in vitro applications, andcombinations and variations thereof.

Other features and advantages of the invention will become apparent fromthe following detailed description, taken in conjunction with theaccompanying drawings, which illustrate, by way of example, variousfeatures of embodiments of the invention.

DESCRIPTION OF THE DRAWINGS

FIG. 1A depicts a method for preparing a human or human-like collagenproduct from harvested human or human-like tissue that may be employedaccording to certain embodiments of the invention.

FIG. 1B is a photograph of human fascia, which may be used as a startingmaterial for preparing a human collagen product.

FIG. 1C is a photograph of human-derived collagen product fiber and/orthread base materials made from human fascia that is or may be preparedfor use as a medical implant in accordance with certain embodiments ofthe present invention.

FIG. 1D is a photograph of human-derived fibrillar collagen product madefrom human fascia that is or may be prepared for use as a medicalimplant in accordance with certain embodiments of the present invention.

FIG. 1E depicts methods for recovering a human-derived collagen productfrom human tissue according to certain embodiments of the presentinvention.

FIGS. 2A-E depict methods of forming an intermediate collagen productusing collagen fiber and/or thread base materials.

FIG. 2F is a photograph of bovine-derived collagen dispersion andhuman-derived collagen dispersion.

FIG. 2G is a photograph of a human-derived collagen product dispersionproduced according to certain embodiments of the present invention.

FIGS. 3A-B depicts methods of forming collagen products using anintermediate collagen product.

FIG. 3C is a photograph of a human-derived collagen product film madefrom human fascia that may be prepared for use as a medical implant inaccordance with certain embodiments of the present invention.

FIG. 3D depicts a method of forming a collagen product using anintermediate collagen product.

FIG. 3E is a photograph of a human-derived collagen product strand madefrom human fascia that may be used or prepared for use as a medicalimplant in accordance with certain embodiments of the present invention.

FIG. 3F is a photograph of another human-derived collagen product strandmade from human fascia that may be used or prepared for use as a medicalimplant in accordance with certain embodiments of the present invention.

FIG. 3G is a photograph of another human-derived collagen product strandmade from human fascia that may be used or prepared for use as a medicalimplant in accordance with certain embodiments of the present invention.

FIGS. 3H-J depict methods of forming collagen products using anintermediate collagen product.

FIG. 3K is a photograph of a human-derived collagen product plug madefrom human fascia that may be prepared for use as a medical implant inaccordance with certain embodiments of the present invention.

FIG. 3L is a photograph of precipitated human-derived collagen productmade from human fascia that is prepared for use as a medical implant inaccordance with certain embodiments of the present invention.

FIG. 3M depicts a method of forming a foam-formed collagen thread madefrom human fascia that may be used as or prepared for used a medicalimplant in accordance with certain embodiments of the present invention.

FIG. 3N is a photograph of a foam-formed collagen thread at a 250×magnification.

FIG. 3O is a photograph of a cross-sectional view of a foam-formedcollagen thread at a 500× magnification.

FIGS. 4A-B depict methods of forming collagen product scaffolds.

FIG. 4C depicts a method for forming an altered collagen productscaffold.

FIGS. 4D-G are photographs of collagen product scaffolds producedaccording to certain embodiments of the invention made from human fasciathat may be prepared for use as a medical implant in accordance withcertain embodiments of the present invention.

FIGS. 4H-I are photographs of perspective and top views of a 0.56 mmfenestrated patterned wound repair scaffold in accordance with certainembodiments of the present invention.

FIGS. 4J-K are photographs of perspective and top views of a fenestratedpatterned wound repair scaffold having a combination of larger andsmaller fenestrations in accordance with certain embodiments of thepresent invention.

FIGS. 4L-M are photographs of perspective and top views of a fenestratedpatterned wound repair scaffold having a composite of fenestrations withembossed channels in accordance with certain embodiments of the presentinvention.

FIGS. 4N-P are photographs of top views of a fenestrated patterned woundrepair scaffolds having a composite of fenestrations with embossedchannels with varying fenestration and embossing patterns in accordancewith certain embodiments of the present invention.

FIGS. 4Q-R are photographs of another fenestrated patterned wound repairscaffold having a combination of larger and smaller fenestrations inaccordance with certain embodiments of the present invention.

FIGS. 4S-T are photographs of perspective and top views of fibermodified wound repair scaffold in accordance with certain embodiments ofthe present invention.

FIGS. 4U-W depicts views of a fenestrated and embossed wound repairscaffold having larger fenestrations and smaller fenestrations withsurface embossing intersecting with the smaller fenestrations inaccordance with certain embodiments of the present invention.

FIG. 5A is an illustration of a collagen product sponge beforecompression.

FIG. 5B is an illustration of a collagen product sheet aftercompression.

FIGS. 5C(a)-(i) are images of a collagen product scaffold in accordancewith certain embodiments of the present invention.

FIGS. 5D(a)-(f) are images of a collagen product scaffold before andafter compression in accordance with certain embodiments of the presentinvention.

FIG. 6 is an illustration of a wound repair dressing constructed from ahuman or human-like collagen product in accordance with an embodiment ofthe present invention.

FIG. 7 is an illustration of a non-woven collagen product fabric.

FIG. 8 is an illustration of a woven collagen product fabric.

FIG. 9 is an illustration of a meniscus or cartilage repair structureformed using a human or human-like collagen product in accordance withan embodiment of the present invention.

FIG. 10 is an illustration of a prosthetic coated with a human orhuman-like collagen product in accordance with an embodiment of thepresent invention.

FIG. 11 is an illustration of an implantable instrument coated with ahuman or human-like collagen product in accordance with an embodiment ofthe present invention.

FIG. 12 is an illustration of a film formed with a human or human-likecollagen product in accordance with an embodiment of the presentinvention.

FIG. 13 is an illustration of a collagen product for use as a vasculargraft or a bilary, neural or small intestine stent, formed with a humanor human-like collagen product in accordance with an embodiment of thepresent invention.

FIG. 14 is a photograph, taken at 100× magnification by scanningelectron microscopy, of a collagen product sponge made from human fasciathat may be prepared for use as a medical implant in accordance withcertain embodiments of the present invention.

FIG. 15 is a photograph of a human-derived collagen product matrixprepared from intermediate collagen product II made from human fasciathat may be prepared for use as a medical implant in accordance withcertain embodiments of the present invention.

FIG. 16 is a photograph of a human-derived collagen product matrixprepared according to known methods.

FIG. 17 is a photograph of a collagen product matrix prepared accordingto certain embodiments of the present invention.

FIGS. 18A-B are photographs of a detailed portion of the collagenproduct matrix shown in FIG. 16.

FIGS. 19A-B are photographs of a detailed portion of the collagenproduct matrix shown in FIG. 17.

FIGS. 20A-D are scanning electron microscope (SEM) photographs of asurface of a compressed collagen product matrix provided in accordancewith certain embodiments of the present invention.

FIGS. 21A-D are scanning electron microscope (SEM) photographs ofanother surface of a compressed collagen product matrix provided inaccordance with certain embodiments of the present invention.

DETAILED DESCRIPTION

Collagen is a connective tissue found in a variety of organisms,including humans and other mammals, aquatic species, avian species, etc.Collagen accounts for approximately 30% of the human body, and at least26 collagen types in the human body are presently known, each addingspecific function(s) to the collagen's structural role as connectivetissue. For example, type I collagen found in tendons and thepericardium and represents approximately 90% of the body's totalcollagen content, type III collagen is found in intestines, type I orIII collagen is found in fascia, i.e., tensor fascia lata, fascia lata,iliotibial band, and/or skin, type II collagen is found in cartilage andtrachea, and type V collagen is found in interstitial tissue andplacental tissue. In one example of the present invention, human fasciaincluding type I collagen, type III collagen and/or elastin may be usedas starting collagen material. In another example, human skin,pericardium, tendon, intestinal tissue, bladder wall tissue, placenta,etc., may be used as starting material. Collagens are described inRobert E. Burgeson and Marcel E. Nimi, Collagen Types MolecularStructure and Tissue Distribution, 282 Clinical Orthopaedics and RelatedResearch 250-272 (1992), which is incorporated by reference herein inits entirety. Fascia, a collagen-containing tissue, is described inKathleen A. Derwin et al., Regional variability, processing methods, andbiophysical properties of human fascia lata extracellular matrix, 84 J.Biomed. Mater. Res. A 500-07 (2008); Ken Nakata et al., Reconstructionof the lateral ligaments of the ankle using solvent-dried andgamma-irradiated allogenic fascia lata, 82 J. Bone Joint Surg. 570-82(2000); and Jason Hodde, Naturally Occurring Scaffolds for Soft TissueRepair and Regeneration, 8 Tissue Engineering 295-308 (2002), which areherein incorporated by reference in their entireties for any purpose.

For purposes of the present invention, the following collagen-relatedterms are used as follows. “Collagen” is a collagen molecule, which maycontain various levels of cross-linking, or a material that is made ofapproximately pure or native collagen fibers or molecules. In somesituations, it may have a portion of the molecule removed by treatment,as in the removal of end telopeptides, etc. A “collagen product” is amedical product containing collagen, but which may also contain otherextracellular matrix constituents (e.g., proteins such as noncollagenousproteins, including growth factors, bone morphogenic proteins (BMPs),etc.), but is processed to exclude cells that are naturally found in thecollagen from the tissue source. Collagen products may be scaffolds,fibrils, fibers, particles, strands, matrices, sponges, foams,foam-formed fibers, etc., or any other suitable form. “Purified collagenproducts” are medical products containing essentially pure collagen andare largely devoid of other natural extracellular matrix components.“Collagen-containing tissue” is a tissue sourced from one of theconnective tissues, such as the fascia lata, placenta, etc., whichcontains collagen, but which may also contain cells and otherextracellular matrix components.

The present invention discloses methods for preparing human-based orhuman-like collagen products including fiber and/or thread basematerials and for producing collagen fibers, fibrils, particles,threads, strands and other implants that use human-based or human-likecollagen products, so that when implanted, no or a low immunogenicresponse in humans results. Human-like collagen is collagen derived froma non-human source that may be treated to result in a collagen productthat is implantable and produces no or a low immunogenic response inhumans. Human-like collagen may be transgenic or genetically engineeredcollagen and may be enzymatically treated to remove immunologicallyactive gylcoproteins and recombinant collagen. The collagen-containingmedical implants provided according to some embodiments have one or moreof the following attributes, including physiologically compatible,sufficiently noninfectious to prevent transmission of viruses and prionsand growth of bacteria (vegetative and spores) and fungi, pliable,available for a wide variety of applications in a variety of shapes andsizes, high in tensile strength, and inert.

According to various embodiments of the invention, any of a variety oftypes of human connective tissue and connective tissue from otherorganisms including genetically engineered animals may be processed toyield human collagen products, or products that do not produce anantigenic response in humans. Collagen products provided according tosome embodiments may be supplemented with cells and/or proteins such asstem cells. Accordingly, collagen products provided according to aspectsof the invention may include collagen with non-collagenous proteinsand/or extracellular matrix, which may or may not be supplemented withcells not naturally present in the source collagen tissue.

Preparing Collagen Fiber and/or Thread Base Materials

FIG. 1A depicts a method for preparing human-derived or human-likecollagen products from harvested human or human-like collagen-containingtissue, according to certain embodiments of the invention. The method ofFIG. 1A includes treating (101) harvested human or human-likecollagen-containing tissue with one or more enzymes to yield a collagenproduct that is suitable for implantation into humans. The enzyme isdeactivated (102) using a non-alkaline enzyme deactivation solution, andthe collagen product resulting from the enzyme treatment is collected(103). Where the original collagen source is human, the resultingcollagen product, e.g., non-immunogenic human collagen fiber, includes apreserved amount of its native human constituents, e.g. native signalingfactors. Collagen products that contain a preserved amount of its nativehuman constituents retains a sufficient or effective amount of theoriginal collagen structure and/or constituents, includingnon-collagenous proteins and/or cross-link chemistries, to be suitableor therapeutically beneficial for its intended application.

FIG. 1B is a photograph of human fascia, which may be used as a startingmaterial for preparing human collagen products according to the methodof FIG. 1A. The human fascia depicted in FIG. 1B includes bandedcollagen evidenced by its vertical stripes that traverse the fasciasample. Collagen fibers bound in fascia are biologically manufactured asextra-cellular protein units (e.g., helical assemblies of amino acids)that are about 300,000 nanometers in length.

FIG. 1C is a photograph of human collagen fiber and/or thread basematerials 104 that may result from processing bound collagen in humanfascia according to the collagen product production method of FIG. 1A.The human collagen fibers 104 may be used as or prepared for use in amedical implant in accordance with certain embodiments of the presentinvention. In FIG. 1C, the prepared human collagen fiber and/or threadbase materials 104 appear beige in color, have a diameter of about thediameter of a human hair to about the diameter of a plant fiber, e.g.,flax, a length of about 10 cm to a particulate size such as about 50microns, with an average length of about 3.2 cm (1.25 in., e.g., commonstaple fiber), are coarse to the touch like coarse cotton, hemp or hair.

FIG. 1D is a photograph of prepared fibrillar collagen 105 made frommilled collagen fibers like those pictured in FIG. 1C, for example. InFIG. 1D, the fibrillar collagen 105 appears like a particulate, but whenviewed microscopically may be fiber-like in appearance. Accordingly, thecharacteristics of fibrillar collagen may be similar to the collagenfiber and/or thread base materials but for the shorter length of theindividual fibrillar collagen grains and possibly smaller diameters.

The above-described method for preparing human or human-like collagenproducts, e.g., fiber and/or thread base materials, involvesenzymatically treating (e.g., ficin treatment, treatment with aproteoglycan-depleting factor and/or glycosidase, or treatment with amild enzyme that does not destroy all non-collagenous proteins in thehuman or human-like collagen) harvested human or human-likecollagen-containing tissue to separate collagen fiber and/or thread basematerials in tissue from other components and to break down peptidebonds between amino acids of proteins in the collagen, while retainingcertain native constituents and receptivity of the human-derived orhuman-like collagen. For example, native constituents may includeuniquely human or human-like biological characteristics, which allow thecollagen product to be biocompatible. In some implementations, theenzyme treatment breaks down some of the telopeptide bonds, whileleaving others intact. This results in partly bound collagen fiberand/or thread base materials retaining a portion of the nativenon-collagenous proteins. The fiber and/or thread base materials arenon-immunogenic due to their human or human-like origins. The method ofFIG. 1A and additional methods for preparing human collagen productswith native human constituents preserved involving the use of enzymetreatment are described in U.S. patent application Ser. No. 11/673,972,filed Feb. 12, 2007, entitled “Methods for Collagen Processing andProducts using Processed Collagen,” which is incorporated by referenceherein in its entirety for any relevant purpose. However, it will beunderstood that collagen products may be prepared using any knownmethod.

FIG. 1E depicts a more detailed collagen product preparation methodaccording to certain embodiments of the present invention. According toone method, finely ground or sliced human collagen-containing tissue(such as fascia, tendon, and/or small intestine submucosa) containingbound collagen is dispersed (110) in a buffer solution at a suitabletemperature and pH. Any suitable buffer solution at any appropriate pHand temperature may be used for providing an environment for theefficient use of a particular enzyme to enable the enzyme to attack andremove material. In the exemplary use of ficin in a buffer solution ofpotassium phosphate (KH₂PO₄) and sodium hydroxide (NaOH), enzymaticactivity is carried out efficiently at a pH of 6.3+/−0.15 and at atemperature of 37° C.+/−1.5° C. However, it will be understood thatbuffer solutions may be suitable at any appropriate pH, such as a pHfrom about 3 to about 9, from about 5 to about 7, or from about 6.0 toabout 6.3. Further, buffer solutions may be suitable at any appropriatetemperature such as between about 20° C. and about 50° C., between about30° C. and about 40° C., or about 37° C. After the collagen-containingtissue is added to a buffer solution, a hydrolase enzyme is added (120).Any suitable enzyme may be used, such as hydrolase enzymes that includeficin, pancreatin, amylases, lipases, and/or various proteolytic enzymessuch as pepsin, trypsin, chymotrypsin, and papain, etc. The hydrolaseenzyme assists in catalyzing the cleavage of proteins and solubilizingother tissue components and non-collagenous impurities. The enzyme maybe kept in solution for an appropriate amount of time for the enzymaticactivity to cause telo-peptide bonds to be broken down, which may allowthe collagen fibers to unwind, as evidenced by the appearance ofstrand-like collagen in solution. Any suitable length of time may beused, including time ranging from seconds to minutes to hours or longer.For ficin, the enzymatic activity occurs for about 30 minutes withintermittent stirring. However, the amount of time the enzymaticactivity the tissue in solution undergoes may be adjusted so that thecollagen fibers from the collagen-containing tissue preserve their fiberorientation and/or native constituents that may provide potentialbenefits. For example, by preserving the original or native constituentsin human-derived collagen products, an implant may provide that, whenimplanted, produces no or a low immunogenic response and allows implantsto disperse and/or cross-link after implantation. In addition, retainingcomponents of the extracellular matrix in the collagen product maypromote healing.

The enzyme-treated collagen fibers are separated (130) from theenzyme-buffer solution and added (140) to an enzyme deactivationsolution selected based on the enzyme used. In one embodiment, whereficin is used, a suitable deactivation solution may be sodium chlorite(NaClO₂) in an ammonium nitrate (NH₄NO₃) buffer solution. Alternatively,the deactivation solution may be an oxidizing agent such as hydrogenperoxide in a sodium chlorite buffer solution. In addition, use of anoxidizing agent may also facilitate in bleaching the fibers. Thecollagen is exposed to the deactivation solution for an amount of timesufficient to deactivate the enzyme reaction, for example about 1 hourwhen the enzyme is ficin. Generally, the enzyme deactivation solutionwill be a non-alkaline solution, which may be less harsh on the fibers,thereby assisting in retention of the natural collagen productconstituents, e.g., collagen, extracellular protein constituents, butexcluding tissue-source-derived cells. Alternatively, the enzyme may bedeactivated in the enzyme solution by changing the temperature or thepH, including raising the pH, of the enzyme solution.

The treated fibers are removed (150) from the deactivation solution andsubjected (160) to a series of washing cycles. Each washing cycleinvolves washing (161) the fibers with a suitable amount of liquid, suchas about 500 ml distilled water, for a suitable period, such as about 15minutes. The collagen product is compressed to squeeze out excess waterand the pH of the distilled water used in washing the fibers is takenafter each wash period (162). The pH after the first and second wash isexpected to be about 7.0+/−0.5, and after a third wash is expected to beabout 7.0+/−0.2. Although three washes of the fibers are described inthe present embodiment, it will be understood that when the pH of thedistilled water reaches a desired pH range, e.g., about 7.0+/−0.2, thewashing process may be terminated. It will be understood that anysuitable pH range can be used for this purpose, including from about 3to about 9, from about 5 to about 7, or from about 6.0 to about 6.3.

In one embodiment, after washing with distilled water, excess water maybe removed from the washed fibers by any suitable method, such ascompression or squeezing. For example, fibers may be hand squeezed,pressed onto a fine screen, vacuumed, centrifuged, rolled betweenrollers separated by a suitable distance, combinations thereof, etc.Optionally, the fibers may undergo (170) a series of de-wateringtreatments. Any suitable treatment may be used, including, by way ofexample only, placing the fibers into a bath of about 100% isopropanol(IPA), heating to about 60° C., and blending for about 15 to about 60seconds. The fibers may remain in the de-watering solution asappropriate, including for about 2 hours at about 60° C., optionallywith intermittent stirring. After the first de-watering treatment, thefibers may be separated from the solution, squeezed, and subjected toanother de-watering treatment, e.g, by treatment in another IPA bathand/or in a 95% ethanol/5% IPA bath (e.g., SDA 3C) for 30 minutes, asdesired. The subsequent de-watering cycle may be repeated in the samemanner, or the de-watering cycles may each have a duration of about 30minutes, for a total of about 1.5 to about 2 hours of de-wateringtreatment. Thus, in various embodiments, the time spent by the fibers inthe de-watering solution may vary. For example, in subsequentde-watering steps, the fibers may remain in the de-watering solution forabout one hour as opposed to about two. In the exemplary use of about100% IPA as the de-watering solution, the IPA, in addition to removingwater from the fibers, also may assist in the removal of any oilspresent in the collagen product mixture.

After the de-watering cycles, the fibers are transferred (180) toanother bath for removing the de-watering solution. For example, whenIPA is the de-watering solution, the fibers may be added to an about100% acetone bath and heated to about 40° C. In addition, the fibers inthe bath may be blended for a period of about 15 to about 60 seconds.Removing the de-watering solution with about 100% acetone, in additionto removing alcohols or water, also may remove any oils potentiallypresent in the collagen product mixture.

The purified fibers may be removed from the bath, separated apart fromeach other, and dried (190) as appropriate. One suitable dryingprocedure includes drying at about 40-45° C. for a period of time, suchas about 4-12 hours, although any other suitable drying procedure alsomay be used. The isolated, enzyme treated human collagen fibers inparticular embodiments includes natural, native collagen constituents,and may be used for a variety of applications including for medicalimplants.

The collagen product preparation and purification method may besupplemented or steps may be altered to preserve a desirable componentsin the collagen product. In one example, a milder processing method maybe used to prepare a collagen product, and the step of adding ahydrolase enzyme, such as ficin, to the collagen-containing buffersolution (e.g., step 120) may be eliminated or replaced in order toprevent denaturing proteins in the collagen and/or to facilitatepreservation of growth factors present in the collagen. By preservinggrowth factors in collagen, inductivity may be facilitated uponimplanting collagen products formed using such an alternative method.Moreover, when a hydrolase enzyme is not used to treat the collagen, anenzyme deactivation step (e.g., step 140) may not be included. Inaddition, and as described further below, milder collagen implantpreparation methods such as cross-linking using transglutaminase may beemployed in combination with the milder collagen processing methoddescribed above.

In a further example, the collagen preparation process may include aterminal sterilization procedure such as dialysis, irradiation,filtration, chemical treatment, or other suitable procedure. Inaddition, collagen or tissue-containing collagen may be blended atvarious other points in the recovery process in addition or as analternative to the blending processes described above. Further,homogenizing the collagen mixture may replace or supplement blending.Moreover, in order to further express water from the fibers afterwashing with distilled water or after the de-watering step, the collagenfibers may be frozen so that any remaining water is expelled.

The collagen preparation methods of the present application may resultin human collagen fibers that are relatively pure, e.g., greater thanabout 70%, greater than about 80%, greater than about 90%, greater thanabout 95%, or greater than about 98%. According to the embodiments ofthe present invention, purified collagen fibers means that the fibersare treated, cleansed, or made suitable for implantation and for use asmedical devices using any suitable collagen preparation, preservation,recovery or purification methods, including the methods described above.Purity does not denote any particular degree of purity, and may includea variety of levels of purity, as appropriate for the intended purpose.

In some embodiments, the collagen recovery and collagen productpreparation method of the present invention does not use an alkalitreatment step, and a non-alkaline solution is used for enzymedeactivation. This is useful according to embodiments of the presentinvention because certain collagen constituents native to humans, e.g.,human growth factors and morphogenic proteins that would otherwise bestripped away by exposure to an alkaline solution, are maintained. Inaddition, because the collagen fibers are derived from humans, harshpurification and/or treatment processes may be unnecessary because humanbased collagen-containing tissue is less likely to be contaminated ascompared to xenogenic collagen-containing tissue. It will be understoodthat collagen product preparation may be accomplished using a variety ofmethods and may include collagen processing steps in addition to or asan alternative to the processing steps described above.

Moreover, because the collagen fibers are sourced from humans, collagenproducts formed from these fibers are less likely to produce animmunogenic response when used for implantation into humans.Accordingly, the human collagen recovery and collagen product productionmethods, according to certain embodiments of the present invention, aresimplified method compared to xenogenic collagen recovery methods, andend products made from the human derived collagen products aredesirable, as they are likely to be accepted at an implant site.

Other collagen product preparation methods may also be employedaccording to embodiments of the invention. For example, harvestedcollagen-containing tissue may be scraped, sliced, e.g., from frozenspecimens, lyophilized, and/or treated enzymatically, etc., to yieldcollagen products including fibers, fibrils, microfibrils, particles,threads, strands, etc.

Prepared collagen products may be stored in fiber, fibrillar (e.g.,milled fibers), microfibrillar (e.g., appear like a fiber when viewedmicroscopically) and/or particulate form (e.g., ground collagen). Suchprepared collagen products may be suitable for medical use in humans intheir native form. Fibrous, fibrillar, microfibrillar and/or particulatecollagen products in their native form may be useful as a hemostat inapplications such as general surgery and/or to treat injuries, e.g., foremergency field treatment or other treatment.

Alternatively, collagen products may be processed into another form of amedical implant. Because the collagen product retains a portion of itscollagen constituents that remain at least partly bound to each otherand retain a portion of native non-collagenous proteins, implants may benon-immunogenic (e.g., due to the human or human-like origin), and mayhave improved elasticity and strength characteristics (e.g., resistantto cracking) compared to collagen implants derived from other sources(e.g., bovine-derived collagen).

Intermediate Collagen Products Produced from Prepared Collagen Fiberand/or Thread Base Materials

Intermediate Collagen Product I: Dispersed Collagen in Solution

According to an aspect of the invention, collagen fiber and/or threadbase materials prepared according to the method of FIG. 1A may be usedas a starting material to produce an intermediate collagen product I. InFIG. 2A, the intermediate collagen product may be provided by dispersing(200) the prepared collagen in any suitable solution including adistilled water and lactic acid solution, or a buffer solution at anysuitable temperature and pH. In various acidic embodiments, the acid canbe selected from both organic and/or inorganic groups.

Intermediate Collagen Product II: Foam containing Collagen and aLeveling Agent

Intermediate collagen product II may be provided according to the methodof FIG. 2B in which a mixture of dispersed collagen fiber and/or threadbase materials and a volume of a leveling agent (e.g., an alcohol thatis about 0.25% to about 15% by volume having a purity of about 50% toabout 99%) are blended 201) resulting in a foam containing at leasthuman-derived collagen and the leveling agent. The foam may be removedand reconstituted (202) as desired. For example, the foam may bereconstituted into a liquid phase such as by changing the gas-containingfoam into a substantially gas-free liquid by centrifuging the foam atabout 1500 to about 3000 rpm for about 1 to about 5 minutes. Thecollagen-containing foam reconstituted into a liquid is an intermediateproduct that may be preserved 203) for subsequent use in medical implantproduction processes. In the present invention, intermediate collagenproduct II is one or both of a foam containing collagen and a levelingagent (e.g., alcohol) or its reconstituted liquid. Medical implantshaving improved properties may be produced using such an intermediateproduct containing and are described in relation to collagen productsbelow.

According to the method of FIG. 2B, when a leveling agent is blended(201) with the collagen dispersion, a separation occurs leaving a foamlayer on top of a flowable liquid. The resulting foam may be separatedand reconstituted (202) into a liquid. The foam layer is believed toconsist of one or more types or constituents that may be different fromthe flowable liquid component because collagen products formed from thefoam is more firm and hard compared to the collagen products from theflowable liquid. While not desiring to be bound to any particulartheory, such physical characteristics may indicate that the foamconstituents may include collagen that is feral/native collagen havingbonds (telopeptide and carbohydrate) that have not been broken orremoved, or may be a specific type or types of collagen, e.g., elastinand type III collagen, and/or may be indicative of additional componentssuch as non-collagenous proteins, e.g., growth factors.

The intermediate collagen product II may also be formed using the methodof FIG. 2C in which a collagen product of prepared human-derived orhuman-like collagen fiber and/or thread base materials are hydrated(2010), dispersed (2020) by blending (2030) or homogenizing, blendedwith a leveling agent (2040), and the foam removed and reconstituted(2050). Collagen fiber and/or thread base materials are hydrated (2010)by adding dehydrated or dried collagen fiber and/or thread basematerials to a media that allows the fiber and/or thread base materialsto become swollen and take up water without denaturing the triple helixstructure of the collagen. Any suitable media may be used, including anacidic media. One example of an acidic dispersing media that is suitablefor dispersion of the human collagen fiber and/or thread base materialsand their resulting rehydration when forming a dura/meningeal repairmatrix is an about 85% lactic acid solution in distilled water at aratio of about 1:500, where the collagen fiber and/or thread basematerials are permitted to swell for about 1 hour at a temperature of ≦about 15° C. Any of these parameters may be adjusted as desired for theparticular application. The reconstituted collagen product in solutionmay have an about 0.5 to about 1.25% collagen density, or an about 0.75%collagen density, although any other values can be used, as appropriate.As used herein, “density” refers to the weight percent processedcollagen fiber (weight/weight or w/w).

After reconstitution, the collagen product dispersion is prepared (2020)by any suitable method. “Dispersion” used in the present applicationencompasses any type of dispersion method including blending, mixing,agitating, and/or suspending in a mixture of water, water and an acid,e.g., lactic acid. One example of a suitable dispersion preparationmethod includes blending (2030) or homogenizing the fiber and/or threadbase materials in solution having a preferred temperature of about 10 toabout 40° C., about 10 to about 35° C., or about 10 to about 20° C., atvarious speeds for intervals of about 5 to about 25 seconds, with a timeperiod of about 10 to about 60 minutes between blending intervals. In aparticular example, a blending series includes blending at low, e.g.,about 14,000 to about 16,000 rpm, medium, e.g., about 16,000 to about19,000 rpm, and high speeds, e.g., about 19,000 to about 22,000 rpm, forabout 10 seconds, with an interval of about 30 minutes between eachblending speed, and is repeated about three times. Any of theseparameters may be varied as dictated by the fiber and density specifiedby the product under construction. According to the presently describedembodiment, the resulting dispersion may have an about 0.75% collagendensity at a pH of about 2.8 to about 3.2, though any desired densityand pH may be achieved.

The blended dispersion may be mixed with a leveling/precipitating agentand blended (2040) in intervals, e.g., low, medium, and high speedblending with about 30 minutes between intervals. Theleveling/precipitating agent cause the collagen to at least partlyprecipitate in the solution. Such leveling/precipitating agents mayinclude polyhydroxy compounds (e.g., ketones such as acetone), alcohols(e.g., ethyl alcohol (EtOH), isopropanol (IPA), surfactants, salts, etc.In one example, an alcohol having a purity of about 60% to about 99%,about 70% to about 99%, about 90% to about 99%, or greater than about99%, at a concentration between about 0% to about 15% by volume, betweenabout 3% to about 6% by volume, or about 5% by volume (e.g., EtOH havinga purity of about 70% to about 99% at a concentration of about 5% EtOHby volume) may be added to the blended dispersion. Alternativelyisopropanol (IPA), e.g. about 60% to about 99% pure IPA, may be usedalone or in combination with EtOH. Other polyhydroxy compounds aredisclosed in U.S. Pat. No. 5,290,558, issued on Mar. 1, 1994, entitled“Flowable demineralized bone powder composition and its use in bonerepair,” which is herein incorporated by reference in its entirety.Moreover, in addition to or as an alternative to the precipitatingmechanisms, dewatering mechanisms are also contemplated which dehydratecollagen in solution causing the collagen to separate from water.

The resulting dispersion includes a foam layer on top of a liquid orfluid layer, each of which may contain a precipitated amount ofcollagen. Any resulting foam is removed and reconstituted (2050) into agas free liquid phase, for example, by decanting the fluid from thefoam, collecting the foam, and centrifuging the foam, e.g., at about2500 rpm for about 1 to about 5 minutes.

When the leveling agents discussed above are used in preparing collagenproduct suspensions for collagen derived from non-human sources, foam istypically reduced or eliminated. That is, a leveling agent for ahuman-sourced collagen product would be an anti-foaming agent for anon-human sourced collagen. For example, upon blending an alcohol, suchas ethanol, with a bovine collagen suspension, foam is typically reducedor eliminated. In the present invention, it has been discovered that byadding a component traditionally believed to be an anti-foaming agentand blending with a collagen product, a leveling effect is insteadproduced, and leveling agents for human-derived collagen products arenot leveling agents for non-human-derived collagen. Where a levelingagent such as EtOH is used, the resulting product (e.g., sponge matrix)may be less susceptible to cracking during lyophilization, may be morehomogeneous (with no or fewer fault lines that could be susceptible totearing), and may have a crystal formation that is more regular, withless sharding.

Intermediate Collagen Product III: Collagen Containing a Leveling Agent

Intermediate collagen product III may be provided according to themethod of FIG. 2D in which collagen fiber and/or thread base materialsare dispersed in a suitable water, lactic acid, and leveling agentmixture and blended (270), and the resulting foam/liquid mixturedefoamed (280) using any known method, such as by adding defoamingagents including surfactants, soaps, alcohols, tension reducingmaterials that are acceptable to biological activity or that are removedin processing, by mechanical means including mixing platforms that donot form surface foams (e.g., airless static, planetary Ross or Leemixers, Graeco in line airless), or by foam elimination using degassing(e.g., centrifuging) and homogenization, ultrasonic and/or vacuum-breakprocesses. The defoamed collagen product mixture is preserved (290) forsubsequent use in forming a medical implant. Accordingly, theintermediate collagen product in the present case includes all of thecollagen product originally dispersed mixed with a volume of a levelingagent.

Other intermediate collagen product production methods may also beemployed. For example, intermediate collagen product III may be producedby reconstituting, dispersing, and blending a collagen product,separating the collagen product's collagen-containing foam andreconstituting, filtering, degassing, and/or centrifuging the dispersionseparate from the foam, remixing the foam component, and/orreincorporating the collagen components, e.g., the collagen productcomponents including the collagen dispersion and the collagen-containingfoam. Intermediate collagen product III may also be provided accordingto FIG. 2E, which includes the method of FIG. 2C plus the introductionof the reconstituted foam component into the decanted collagen fluid andmixing (2060) to form a homogenous collagen product mixture. In someimplementations, the homogenous mixture is refrigerated, e.g., at about4° C. to about 10° C., for about 3 to about 24 hours before undergoingfurther processing. In further implementations, the decanted collagenfluid is refrigerated before the foam component is re-mixed to form ahomogenous mixture.

The third intermediate collagen product may provide various advantagesdue to its leveling agent (e.g., alcohol) content and due to itsretention of all of the originally dispersed collagen product. Certainadvantages are provided further below in relation to the collagenproduct scaffold production methods that involve freezing the collagenproduct dispersion.

The methods described above in relation to intermediate collagenproducts II and III differ from other collagen product production andprocessing methods because typically leveling agents for human-derivedcollagen product are not leveling agents for non-human-derived collagen,and the type of foam produced when blending human-derived collagenproduct with a leveling agent is not produced upon blending collagenderived from other non-human-like sources (see FIG. 2F, discussedbelow). Even where foam is produced in human-derived ornon-human-derived collagen product, it would typically be consideredwaste and discarded, while the liquid homogenous phase would be retainedfor further use. This is because the foam: 1) is not homogeneous withthe rest of the dispersion, 2) is not a typical result when blendingother non-human forms of collagen with alcohol, 3) is persistent anddoes not dissolve into solution unless manipulated mechanically and/orchemically, 4) may contain a relatively small amount of the dispersedcollagen and thus be easily discarded without affecting the batch size,and/or 5) may be easily removed by pouring and employing a weir orspatula.

Each of the above-disclosed intermediate collagen products I-III, whenin dispersion, may appear to have a greenish/yellow tinge, that isslightly thickened, yet self-leveling. When the dispersion includesalcohol or another leveling/precipitating agent, mixing and/or shakingthe dispersion creates a foam layer containing collagen and alcohol.FIG. 2F is a photograph of bovine-derived collagen dispersion (left) andhuman-derived collagen product dispersion (right) after blending, eachdispersion having about a 0.75% collagen density in an about 1 Literbatch having about 50 ml of 99.99% EtOH and about 5 ml of 85% lacticacid. From FIG. 2F it can be seen that human-derived collagen product indispersion (right) produces a foam layer 295 when blended, whereasbovine-derived collagen in dispersion (left) does not. FIG. 2G is apicture of the human-derived collagen product dispersion from FIG. 2F,in which foam layer 299 having about a 6 cm depth can be more easilydiscerned. The human-derived collagen product foam pictured in FIG. 2Gis persistent foam that is sustained over time, and no observable changein the foam occurs when it is refrigerated for about a month. Inaddition, when the human-derived foam is permitted to dry at roomtemperature, a nearly transparent film is produced that is flexible andexhibits some plasticity. While not desiring to be held to anyparticular theories, it is believed that human-derived collagen productfoam includes constituents or properties different from bovine-derivedcollagen at least because mixing a bovine collagen suspension does notproduce persistent foam. Additional reasons human-derived collagen foamis believed to have unique constituents are discussed below in relationto producing collagen scaffolds using the foam component of ahuman-derived collagen suspension. Possible reasons for the differencesin bovine and human collagen products include the relative age of thecollagen specimen results in a different amount of cross-linking,bipedal vs. quadrapedal locomotion cause fascia to differ, differingfood intake or uncontrolled substances can vary the composition ofcollagen-containing tissue, human collagen-containing tissue may beaffected by different diseases, weight is controllable for bovinesamples, and bovine samples may have increased growth hormones.

Various medical implants may be constructed using any of theintermediate collagen products described above, and include: films,coatings, drug delivery devices, monofilament fibers, foam formedfibers, woven structures, mesh structures, injectable substances,vascular/neural grafts, bilary, neural and/or small intestine stents,tubes, plugs, repair matrices, scaffolds, and/or hemostats. Additionalmedical implants that may be produced are described in U.S. Pat. No.6,485,723, issued Nov. 26, 2002, entitled “Enhanced submucosal tissuegraft constructs;” U.S. Pat. No. 7,147,871, issued Dec. 12, 2006,entitled “Submucosa gel compositions;” U.S. Pat. No. 4,956,178, issuedSep. 11, 1990, entitled “Tissue graft composition;” and U.S. Pat. No.5,554,389, issued Sep. 10, 1996, entitled “Urinary bladder submucosaderived tissue graft;” and in the article, Stephen F. Badylak, TheExtracellular Matrix as a Biologic Scaffold Material, 28 Biomaterials3587-3593 (2007), which are incorporated by reference herein in theirentireties. The various implant fabrication processes described belowuse one or more of the intermediate collagen products to yield acollagen implant that is suitable for implantation into humans. However,it should be understood that, in some embodiments, the intermediatecollagen products may be suitable as a finished product for implantationinto humans without further processing.

Medical Implants Formed from Intermediate Collagen Products I-III

Collagen Product Films/Coatings

A film barrier 1201 from FIG. 12, may be produced using any one of theintermediate collagen products described above. According to FIG. 3A, afilm barrier may be fabricated by depositing (310) the intermediatecollagen product in a thin layer and removing (320) the liquidcomponent. “Removing the liquid component” used in present applicationencompasses any type of moisture removal process and includes freezingand lyophilizing, lyophilizing, evaporating by heating, allowing thedispersion to remain at room temperature while the liquid componentevaporates naturally, or any other suitable moisture removal process.The resulting sheet may be used as a film, or may be processed furtherto achieve desired characteristics. In addition, before removing liquidfrom the intermediate collagen product, other biocompatible materialsmay be mixed with the collagen suspension where certain performancecharacteristics are desirable.

According to FIG. 3B, an intermediate collagen product may be processed(330) into a gelatin, and the gelatin may be used as a coating to coat(340) medical implants. In certain implementations, various prosthetics,e.g., prosthetic 1001 in FIG. 10, and/or instruments, e.g., instrument1101 in FIG. 11, may be coated with the gelatin produced from theintermediate collagen product.

Films and/or coatings may be useful, for example, in barrier dressings(e.g., adhesion barriers and barriers to liquids), occlusions,structural supports, osteochondral retainers for cells/matrices (+/−analgesic), drug delivery devices, e.g., collagen product coatingcombined with analgesic, anti-inflammatory, antibiotic, and/or growthfactors, and wraps for bone defects. In addition, catheters and stentsmay be coated. In a further implementation, a plasticizer, bioactive,bioabsorbable, soluble, and/or biocompatible component may be combinedwith the collagen product or the gelatin formed from human-derived orhuman-like collagen product in order to form a collagen product paste,slurry and/or putty, etc. In a further embodiment, a collagen productgel or film may be combined with a structural backing, e.g., a thinfilm, e.g., about 100 to about 200 um or about 0.05 to about 0.5 mm,such as a polylactide and/or chitosan film. The collagen productcoatings and/or films may provide one or more durable layers of collagenproduct that may be used in general medical, cardiovascular, and/ororthopaedic settings.

A human-derived collagen product film 341 made from human fascia isdepicted in the photograph of FIG. 3C, which may be prepared for medicaluse in humans in accordance with certain embodiments of the presentinvention. Exemplary physical characteristics of the collagen productfilm and/or coating may depend on the type of starting material and/orintermediate collagen product or products used to produce the filmand/or coating, and may include: pliable, flexible, resistant tocracking, strong, and/or dense.

Collagen Product Strands, Fibers, Filaments, Threads and Foam-FormedStrands, and Collagen Products Formed Therefrom

Collagen products including collagen strands, fibers, filaments, threadsand foam-formed strands formed from collagen base materials and/orintermediate collagen products, and collagen fabrics produced therefrom,are provided according to certain embodiments. Collagen strands arelengths of collagen material generally having a length that is longerthan the width of the strand. Collagen fibers are arrangements ofgenerally aligned and directionally oriented collagen materials having amaterial composition that includes collagen, and a selected strength forintegrating the fiber into more complex structures such as collagenthreads and collagen textiles, including collagen webs and non-woven andwoven collagen fabrics. Collagen fibers may be natural fibers having awide variety of assembled lengths, which may be twisted to form uniformyarns and threads of desired dimensions and strengths. Collagen threadsmay be a bundle of twisted fibers formed into a length for use intextile applications, for example. Collagen filaments may be formed ofone or more monolithic collagen structures to provide collagenmono-filaments or multi-filaments. Collagen filaments may be fabricatedfrom extruding and/or spinning processes. Foam-formed collagen strandsare an open cell network or matrix of collagen formed into a strand andare described below.

Foam-formed Strands: Intermediate collagen products may be processedinto a foam-formed collagen strand according to the method depicted inFIG. 3M. According to FIG. 3M, the intermediate collagen product isdeposited (3310) as a dispersion into a patterned plate having anegative relief pattern designed for forming a desired shape and size ofstrand. The plate containing the intermediate collagen product isprocessed (3320) so that the collagen within the collagen dispersiontakes a shape complementary to the patterned plate, and achieves adesired porosity and density. Processing steps may includelyophilization, cross-linking, coating, and/or strand removal followedby twisting and compression. The resulting foam-formed strand includes aporous foam structure that may facilitate movement of biologicalmaterials (e.g., cells and fluid) within and through spaces of thereticulated cells of the collagen fiber walls. In various embodiments,reticulated cells are networked, communicating, or connected. Thereticulated cells of the foam-formed collagen strand form an open cellnetwork or matrix, which allows the biological materials to enter andmove with relative freedom in a direction following the strand lengthwhen the strand is implanted. In various embodiments, the reticulatedpores are greater than 0.60 mm, 0.70 mm, 0.80 mm, 0.90 mm, 1.0 mm, 1.1mm, 1.2 mm, 1.3 mm, 1.4 mm, or 1.5, or less than 2.0 mm, 1.9 mm, 1.8 mm,1.7 mm, 1.6 mm, 1.5 mm, 1.4 mm, 1.3 mm, 1.2 mm, 1.1 mm, 1.0 mm, 0.9 mm,0.8 mm, or 0.7 mm.

According to certain implementations, the plate used to receive thecollagen dispersion includes a grooved area having a predeterminedshape, such as linear grooves or one or more spiral shaped grooves,curved grooves, any other desired configuration, and combinations ofthese. The plates may be configured so that a predetermined volume ofthe intermediate collagen product is deposited in the grooves. The platemay be constructed of materials that readily release the foam-formedcollagen strand, such as clay, stainless steel, aluminum, plastics. Theplate may be treated with a non-stick material such as Teflon tofacilitate the strand removal. Methods involving the use of plates mayfacilitate providing a foam-formed strand with a finished edge, free ofdefects. However, certain implementations may not use a plate, butinstead may use other forming means such as by cutting pre-lyophilizedcollagen sponge into strands, assembling the lengths of the strandsend-to-end, and lyophilizing and cross-linking the strands to form asingle length of a foam-formed collagen strand.

In one embodiment, the plate includes U-shaped grooves with dimensionsfor providing a partially rounded foam-formed collagen strand that isinitially about ⅛″ to about ¼″ wide and about ⅛″ to about ¼″ tall, orwhich has a cross-section that is about ⅛″ to about ¼″, or which rangesfrom mils to about an inch in width and mils to about an inch in height.However, the grooves may have a number of cross-sectional shapes toprovide the desired strand shape. In addition, the width and depth ofthe grooves may vary so that the width and height of the foam-formedcollagen strand is about 1/16″ to about ⅛″, from about ⅛″ to about3/32″, from about 1/16″ to about ¾″, and from about 1/32″ to about ⅝″.It will be understood that the width and height of the strand may differrelative to each other, and that the cross-sectional shape may beirregular or substantially consistent along the length of the strand,which may be about several inches (such as 12 inches) to about 30 feetlong. FIGS. 3N and 3O are photographs of twisted foam-formed collagenthreads. In FIG. 3N, the collagen thread is shown at a 250×magnification. In FIG. 3O, the photograph is of a cross-sectional viewof a h-collagen coated foam-formed collagen thread at a 500×magnification.

The intermediate collagen product may be deposited (3310) by casting asa dispersion and pouring or extruding into the plate. The collagendispersion may have any desired collagen density, including from about0.001% to about 20%, about 0.1% to about 10%, about 0.5% to about 5%, orabout 0.5% to about 1.5% collagen density. In one example, thedispersion may have an about 0.75% collagen density.

Upon initial processing (3320), such as by removal of the liquidcomponent, e.g., evaporation, lyophilization or freezing andlyophilization, the formed strand may have an initial strength similarto a lyophilized collagen sponge having a similar cross-sectionaldimension, which may correspond to the selected collagen density. Withincreasing collagen density, the strength of the foam-formed strandincreases.

Additional processing, including collagen cross-linking, may take placewhile the dispersion remains on the plate, following removal of theformed strand, or during another preparation phase. When the collagen iscross-linked in its dispersed form, e.g. while the dispersion remains onthe plate, the dispersion may include cross-linking components and mayfacilitate strand formation. After removal from the form, thepost-formed strand may be cross-linked using one or more chemicalcross-linking agents such as those disclosed below in the sectionentitled “Methods for Preparing Collagen Product Scaffolds Formed fromIntermediate Collagen Products II-III.” The post-form cross-linking maytake place pre- or post-compression and/or pre- or post-turning, whereapplicable. In certain implementations, multiple foam-formed collagenstrands may be cross-linked end-to-end to form a continuous strandhaving a length spanning hundreds of feet. In other implementations,multiple foam-formed collagen strands may be cross-linked side-by-sideto form a collagen strand having a diameter that is an order ofmagnitude larger than the diameter of a single foam-formed collagenstrand.

Upon its removal from the plate, the foam-formed collagen strand may befurther processed. According to certain implementations, the foam-formedcollagen strand may be compressed. Concurrently with or followingcompression, the foam-formed collagen strand may be turned or twisted toreach a desired thread dimension, spiral orientation, and/or density.Compressing and/or twisting reduces the diameter of the foam-formedcollagen strand down to a fraction of its initial diameter. Uponcompressing and/or twisting, a foam-formed collagen strand having aninitial cross-sectional diameter of about ¼″ (e.g., derived from a ¼″tool), may have a cross-sectional diameter of about 0.010″ to 0.012″,whereas a compressed and/or twisted about ⅛″ diameter foam-formedcollagen strand may have a cross-sectional diameter of about 0.006″ to0.009″. The resulting compressed and/or twisted foam-formed collagenstrand appears thread-like, and exhibits an increased strength due tothe compressed nature of the matrix or network of reticulated cells.Spiraling the foam-formed collagen thread also increases uniformitywhile providing directional cell growth opportunity. In addition, thenetwork of reticulated cells may be altered upon compression and/ortwisting, which tends to close-off a portion of the reticulated cellsthat were open upon initial processing. Strand compression and/ortwisting may be performed by hand or via processes involving twistingmachines.

In certain implementations, the foam-formed collagen strand may becoated to impart a variety of properties. Coatings may be provided tothe strand upon initial formation, upon compression and/or twisting, orin connection with lyophilization and/or cross-linking. Coatingscompositions may include collagen, pharmacologic, synthetic and hybridmixtures. Collagen coatings may serve to prevent or delay degradation ofthe collagen. For example, collagen fibers used as core fibers may becoated in order to delay the degradation of the core of a collagenproduct in a controlled manner. This provides for the preservation ofengineered characteristics such as tensile strength, which may be usefulin facilitating healing and returning the native tissue to its nativetensile strength during the healing process. Collagen coatings may alsoinclude drugs, therapeutic agents or other non-collagenous componentsthat are released over time. Time release mechanism may be influenced bybulk erosion, surface dissolution or metabolic digestioncharacteristics. Taking one or more of these characteristics intoaccount, the components may be provided as coatings in a desired amountin order to control or influence a variety of conditions. For example, anon-steroidal anti-inflammatory drugs (NSAIDS) may be incorporated intoa coating to control and meter inflammation in order to induce,accelerate and/or promote healing. Analgesics may also be incorporatedinto a coating in order to control pain. Collagen coatings may alsofacilitate the prevention of adhesion. For example, coatings of sodiumcitrate disposed on a collagen product may prevent thrombosis andfibrotic tissue from attaching one organ or tissue plane to another. Ina particular example, coatings disposed on a collagen product used inovarian or fallopian surgery may facilitate maintaining fertilitypost-surgically. In open heart surgery applications, coatings forpreventing adhesion may prevent attachment of the heart to the sternum,which could otherwise result in restraint of the heart muscle andreduced efficacy.

The above-described processing methods involved in preparing thefoam-formed collagen strand may be tailored to achieve desiredfoam-formed collagen strand properties including collagen foam density,inner foam structure, and/or strength. The collagen density of theintermediate collagen product dispersion is relevant to the strand'scollagen foam density. The degree and type of collagen cross-linking mayaffect the porosity and/or strength of the foam-formed collagen strand.Methods of cross linking can include a) altering pH, freezing rate, andfreezing point by altering the chemistry of a mixture, such as by addingalcohol to control collagen matrix/sponge porosity. In variousembodiments, pore uniformity and size can be used to control matrix/foamintegrity as well as resistance to tearing. Using aldehyde cross-linkingcan be used to influence strength in terms of ‘shrink’ resistance,tensile performance and resistance to degradation. Other cross linkingchemistries can increase resistance to in vitro degradation and tensilefailure. In addition, the degree of strand turning or twisting affectsthe inner foam structure, which tends to reduce foam porosity by closingreticulated cells initially having an open pore structure, or byreducing the available channels for biological materials to enter andmove freely. By adjusting foam density and/or the porosity for cellularmovement, it is possible to match the resorption/remodeling of theimplant material to the healing rate of the repair site. Density can becontrolled by regulating the quantity of collagen included in itsdispersing media. Porosity can be controlled by altering pH, density ofcollagen, freeze rate and freeze point adjustment, such as byintroducing alcohol.

In another implementation, the collagen dispersion may include EtOH formanaging ice crystal formation and reducing sharding, resulting in apost-lyophilized foam-formed collagen strand having a substantiallyconsistent reticulated cell size, which may facilitate predicting rateof movement of biological materials over time. In various embodiments,from about 3% to about 5% or about 7% by volume to volume alcohol isadded. In more specific embodiments, about 5% is used.

In alternative embodiments, it may be desirable to twist and compressthe foam-formed strand to an exaggerated degree in order to provide animpenetrable strand having high strength. In other embodiments, however,a high-strength strand may be formed that includes a desirable degree ofporosity to facilitate movement of biological materials.

Foam-formed collagen strands may be used in further processes includingbraiding, weaving, knitting, felting and/or in fabric production, forexample.

Extruded Strands: According to FIG. 3D, the intermediate collagenproduct may be processed into a strand by extruding (350) theintermediate collagen product into a strand, removing (360) the liquidcomponent from the collagen product, e.g., by lyophilization ordewatering in which the strand is extruded directly into a solvent mediato extract water, and cross-linking (370) the collagen product to form across-linked strand. In some implementations, pH adjustment andcross-linking (370) the strand may be achieved within the dewateringsolvent media. In addition, the collagen product strand may becompressed (380), woven, knitted, and/or braided (390) into a patch.Alternatively, the strand may be cross-linked in-situ during theextrusion process.

The strand, according to certain configurations, may have monofilamenttype structure, or multi-filament structure, and may appear like finefishing line, sewing thread, yarn, or a suture. The photographs of FIGS.3E-G are collagen product strands. The strand pictured in FIG. 3E is amonofilament strand 351 similar to a fishing line. FIG. 3F is anotherphotograph of collagen product strands 352 wrapped around a spindle.FIG. 3G is another photograph of a towed and twisted collagen productstrand. As compared to the collagen product strand in FIG. 3F, thecollagen product strand 353 in FIG. 3G is more robust and appearsyarn-like. Each of the strands pictured may be prepared by wet extrudingthrough a spinneret (single and multi-ported) resulting in a multitudeof collagen product fibers being assembled in a linear agglomerationwhile being cross-linked, precipitated, and dewatered. The strand may beabout 50 nanometers to about 3 millimeters, or about 50 microns to about200 microns in diameter. The strands may be a fiber mass of looselyformed fibers that cling together by crimping or by their surfacegeometry, similar to how cotton fibers cling together. The strands maybe slightly twisted or spun to form a strand having a more uniformdiameter resembling sewing thread. In addition, the strands may beformed into a ribbon by positioning multiple strands side-by-side anddrying the strands. In another example, the ribbon may be twisted toform a collagen product strand similar to a sewing thread, which may ormay not be thicker than the twisted strand of collagen product describedabove. For example, a collagen product rope may be formed using thecollagen product strand, which may have a diameter of between about 200microns to about 3 millimeters. The strands resembling sewing thread maybe about 100 microns to about a millimeter or more (e.g., about 2 mm toabout 5 cm) in diameter. Collagen product strands may be used in furtherprocesses including weaving, knitting and/or braiding, for example.

Strands formed by Electrostatic Spinning: Alternatively, the stand maybe formed by electrostatic spinning in which high electrical energy isused to form a Taylor Cone and send fiber bursts to a ground plate fordeposition. The fiber begins in a collagen product dispersion that exitsthe electrostatic cone in a liquid form and is dried into a fiber duringits flight to a grounding plate. The resulting fiber may be about 50 toabout 400 nanometers in diameter. Each of the above-described collagenproduct strands may be prepared for use as a medical implant or may befurther processed into, for example, a collagen product patch, inaccordance with certain embodiments of the present invention.

The collagen strand formed from the intermediate collagen product byfoam-forming, extruding or electrostatic spinning may be used to producemedical implants or may be used alone for suturing, for example. Incertain implementations, the foam-formed collagen strand with its foamfiber core may be combined with various types of non-collagenousfilaments (i.e., synthetic polymer) or hybrid (i.e., composed partiallyof collagen and partially of another non-collagenous material) filamentsby braiding or cabling. For example, the foam-formed collagen strand mayserve as a core for a braided cable, e.g., a series of braidedfilaments, having various engineered functions. Braid-based productsincluding foam-formed collagen strands may be used in cable tensionbands, and rotary cuff and suture applications.

In another example, the foam-formed collagen strand and/or the cablesand braids formed therefrom may be knotted, looped or woven in knittingor weaving processes to form repair scaffolds. Using foam-formedcollagen strands in scaffold applications may promote directionalmovement of biological materials along the length of the strand. It maybe appreciated, however, that scaffolds may be engineered using thefoam-formed collagen strands to conduct biological materials in a singledirection (e.g., towards the wound site), bi-directionally (e.g.,towards and away from the wound site), or multi-directionally (e.g.,transverse movement about and around the wound site).

When the collagen strand formed from the intermediate collagen productby forming, extruding or electrostatic spinning is used to producemedical implants such as a repair patch or sling (FIGS. 7 and 8), apliable sheet of collagen product may result, which may be suturedaround the area to be repaired.

According to certain implementations, a non-woven repair patch (FIG. 7)may be formed using a collagen product thread by employing a feltingprocess.

In alternative implementations, a repair patch 801 or sling may bewoven, braided, and/or knitted (FIG. 8), or may be formed from acombination of two or more of weaving, braiding (flat,three-dimensional, etc.) and knitting (warp knitting orthree-dimensional knitting involving knitting two or more knittingprocesses).

Additional tissue repair fabrics and tissue repair fabric productionmethods are described in U.S. Pat. No. 5,733,337, issued on Mar. 31,1998, entitled “Tissue Repair Fabric,” which is incorporated byreference herein in its entirety. In a further alternative, the collagenproduct sheet may be formed by any of the above-mentioned processes andformed into tubes, e.g., tubes 1301 from FIG. 13, for applications suchas vascular grafts and bilary, neural and/or small intestine stents,described further below.

Repair patches may be useful in applications such as: hernia repair,bladder repair (bladder slings), spinal tension band, tensile loadedimplantable products, annular repair for the spine, and/or for repair,reconstruction, augmentation or replacement of a sphincter, meniscus,nucleus, rotator cuff, breast, bladder, and/or vaginal wall.Accordingly, the repair patch or sling may be used in general surgicalsettings, in spinal, vascular, and/or neurosurgical settings, and/or forsports medicine surgical applications. In addition, collagen strands maybe used as reinforcements in a weave or net within a collagen sponge.Furthermore, the aforementioned collagen implants may be furtherprocessed upon formation such as by further cross-linking, and/orcoating.

Injectable Collagen Products

The intermediate collagen products may be use to produce an injectableform of collagen. According to FIG. 3H, the intermediate collagenproduct may be treated (3001) with pepsin to remove telopeptides, andsubjected to an alkali treatment (3002) so that, when implanted, thecollagen product produces no or a low inflammatory response. Theinjectable collagen product may be useful in applications such as: scarrevision, contracture revision, hypertrophic scar treatment, cosmetics,cosmetic surgery, wrinkle removal, cell delivery, drug delivery, clearcollagens, dispersed collagens, micronized collagens (cryogenicgrinding), and/or collagen product mixtures, e.g., collagen mixed withthrombin. Accordingly, injectable collagen products may be useful invarious medical fields including plastic surgery, dermatology, and/oramputee stump revision.

Some methods that use non-human fascia to prepare soft tissue filler,which may be useful in accordance with some embodiments of the presentinvention, are described in U.S. Patent Application Publication No.2002/0016637, published on Feb. 7, 2002, entitled “Soft Tissue Filler;”and in Steven Burres, Md., Preserved Particulate Fascia Lata forInjection: A New Alternative, 25 Dermatologic Surg., 790-794 (October1999) which are incorporated by reference herein in their entireties.

Collagen Product Tubes

The intermediate collagen product may be processed and formed into tubesfor use as vascular grafts and bilary, neural and/or small intestinestents (FIG. 13). Various processing techniques may be employed toconstruct a tube-like structure that may serve as vascular material oras a stent. According to the method of FIG. 31, vascular/neural graft orstent is made by adjusting (3010) the pH of the intermediate collagenproduct to a more basic condition, resulting in the collagen productfiber and/or thread base materials partly or fully precipitating. Theprecipitated collagen product fiber and/or thread base materials may befirm and entangled, while being at least partly suspended in the watermedia, and may be easily be spun or wrapped (3020) onto a dowel ormandrel of a size suitable for reproducing the vascular/neural tissue tobe repaired. The resulting grafts may be cross-linked (3030) to maintaintheir shape after removal of the dowel. In addition to fabricatingvascular and neural grafts and/or stents using the process describedabove, other implants that may be fabricated include: maxillaryreconstruction tubes, which also contain mineral or allograft material,and/or hernia repair implants. Collagen product tubes may accordingly beuseful in craniomaxillofacial, vascular, neurological, and/or generalsurgical applications.

Collagen Product Plugs

Other medical implants such as plugs, meniscus repair structures, orcartilage repair structures 901 (FIG. 9) may be formed using theintermediate collagen product of the present invention. For example, inthe method of FIG. 3J, an implant structure is formed by depositing(3100) a collagen product dispersion in a mold having a desired shape,removing (3200) the liquid in the collagen product dispersion, forexample by lyophilizing, and cross-linking (3300) the implant in orderto retain its desired shape. For an implantable plug, the dispersion maybe deposited into a bullet-like mold, for example. Liquid may be removedfrom the dispersion using any suitable method including bylyophilization. Subsequently, the lyophilized collagen product structuremay be cross-linked so that the implant retains its shape. In anotherexample, the collagen product dispersion is mixed with a suitablebiocompatible substance before depositing the dispersion into the mold.Collagen product plugs may be useful in cardiovascular surgicalapplications where the plugs may be inserted into vasculature to treatcertain conditions, such as “blue baby” conditions. Collagen productplugs may be compressed by, for example, twisting, so that they can beinserted into the surgical site through a catheter. Upon rehydration inthe surgical site, the plugs will assume their original shape.

A collagen product plug 3301 is depicted in the photograph of FIG. 3K,in which the collagen is processed in a similar manner compared to thehuman-derived collagen product scaffolds described below except thecollagen product is bounded by a form or a mold. From FIG. 3K, thecollagen product plug 3301 has about a 22 mm diameter. However, thecollagen plug may be of any suitable diameter depending on its intendeduse.

In Vitro Collagen Product Applications

The intermediate collagen product may be used in any suitable context.For example, the intermediate collagen product may be useful for invitro applications and may be prepared for in vitro applications byvarious methods. For example, collagen products may be precipitated byany suitable method. Alternatively, the intermediate collagen productmay be preserved, e.g., FIG. 1A, and may be used for in vitroapplications. The intermediate collagen product or the precipitatedcollagen product may be useful in applications such as for themanufacture of ex vivo tissue engineered products, cell culture media,and/or assays. Accordingly, collagen products for in vitro applicationsmay be used in the cell tissue and engineering industry and/or in themedical testing industry.

FIG. 3L is a photograph of precipitated collagen product fibers 3302 ina vial having been precipitated from a collagen product dispersion. Theprecipitated collagen product may be of a self-assembling type where,once a precipitating agent is added to the collagen product suspension,collagen product fibers precipitate into the solution that appear like abroken-apart cotton ball. Such an en masse precipitated collagen productis easily recovered from the solution and may be used as a medicalimplant, or may be further processed depending on the in vitroapplication of the human-derived collagen product.

Collagen Product Scaffolds

Method for Preparing Collagen Product Scaffolds from IntermediateCollagen Product I

Intermediate collagen product I may be formed into a collagen scaffoldaccording to the method described in FIG. 2D in U.S. patent applicationSer. No. 11/673,972, filed Feb. 12, 2007, entitled “Methods for CollagenProcessing and Products using Processed Collagen.”

Methods for Preparing Collagen Product Scaffolds Formed fromIntermediate Collagen Products II-III

Alternatively, intermediate collagen product II or III may be formedinto a collagen product scaffold according to the methods describedbelow. According to FIG. 4A, an intermediate collagen product producedaccording to FIG. 2B, 2C, 2D or 2E is frozen (401) and the liquidcomponent is removed (402) to yield a medical implant. It will beunderstood that additional processing steps may be involved in preparingcollagen product scaffolds, which may include the formation of holes orfenestrations in the intermediate collagen product prior to freezing(401) described further in relation to FIG. 4B.

According to the invention, an alcohol, such as EtOH, or anothersubstance, which forms the intermediate collagen product II or III,remains in the dispersion when the mixture is frozen and causes thefreezing characteristics of the intermediate product to be altered. Forexample, the crystal size of the ice crystals in the frozen intermediateproduct containing alcohol may be controlled. Other agents also may beused to control ice crystal formation and size. As a result, the qualityof the finished collagen product may be more accurately predicted and/orcontrolled because controlling crystal size allows the size of the voidspaces, i.e., interstices, resulting from removal (such aslyophilization) of the water and alcohol component, and the fiber sizeof the collagen product to be controlled. Thus, collagen products may beproduced that have void spaces similarly sized, e.g., a narrow sizedistribution of the void spaces, distributed evenly, e.g., homogenous,with a desired pore density, resists cracking, has a high degree ofplasticity, and/or an end product that is stronger compared to collagenproducts not having alcohol in the dispersion. That is, freezingcharacteristics of collagen product dispersions where there is no agentcontrolling ice crystal size may result in uncontrolled ice crystal sizeduring freezing, resulting in a wide range of void space sizes. As aresult, large shard ice crystals may result in large and/or uneven voidspaces in the finished products, which may cause weaknesses and/orbrittleness in the finished product.

Another method for producing a collagen product scaffold provided inFIG. 4B. According FIG. 4B, a wound repair scaffold or matrix isproduced by following the steps of FIG. 2B, 2C, 2D or 2E. Theintermediate collagen product in alcohol may be filtered (430), whichmay enhance uniformity. For example, the dispersion may be filteredthrough a woven screen mesh having 0.024″ round or square openings,through a woven or perforated stainless steel screen having about 8 to24 gauge holes, or through a screen having a series of openings thatform about a 30% open area. Filtering may be repeated to ensure auniform dispersion. In some embodiments, the filtering is conducted at adesired temperature, e.g., a temperature of ≦ about 15° C., or any otherdesired temperature or range of temperatures.

The filtered collagen product may be subsequently degassed (440), whichmay affect the porosity of the finished product. In one example, thecollagen product is degassed via centrifugation, e.g., at about ≦15° C.,which can eliminate large irregular pockets of gas or air. In additionor alternatively, the collagen product may be degassed by vacuuming. Thedegassed product may be collected by slow decant while discarding anyprecipitate, such as dense collagen particles resulting from lactic acidnot penetrating interior collagen product fiber and/or thread basematerials in a dense fiber bundle or pellet.

The filtered collagen product is or can be loaded (450) into stainlesssteel or aluminum trays to a depth ranging from any thickness greaterthan 0 mm to several inches thick, or about 0.5 mm to about 35 mm, or ata depth of about 4 mm. For example, some dispersion depths may includeabout 5, 7, or 12 mm. However, the depth the collagen product is loadedinto the trays is based on the desired end product thickness, which maybe about 0.1 cm to about 15 cm in height, width, and depth, or about 12cm to about 15 cm in height and width and about 0.1 mm to about 12 cm indepth, or any suitable dimension.

In some embodiments, openings may be formed (455) in the collagen byinserting pins or structures of a diameter or size selected to form adesired opening size into the filtered collagen within the trays. Forexample, stainless steel pins or structures, poly-fiber monofilamentsand/or rods (e.g., Teflon rods) may be inserted along the x-axis,y-axis, and z-axis of the collagen layer, i.e., along the length, widthand height of the collagen product within tray, to provide a selectednumber of openings having a selected pattern. The pins or structures maybe of any desired size, geometry, curvature, and configuration. In oneexample, a plurality of channels generally oriented in a firstdirection, i.e., channels that traverse the length of the filteredcollagen, may intersect with a plurality of channels generally orientedin a second direction, i.e. channels that traverse the width of thefiltered collagen. Channels may directly intersect, in that they connectwith one another, or channels may overlap one another but not directlyintersect, as when viewed perspectively. Any number or fraction ofchannels may directly intersect, or overlap, from none to all channels.Further, channels may be within planes, where some channels intersect(or overlap) in a plane or region, and other channels intersect (oroverlap) in other planes or regions, where such planes or regions can beconsidered as layered or stacked within the length or width of thematerial. In certain implementations, the ratio of openings within thecollagen may be about 1%, about 5%, about 10%, about 20%, about 40%,about 50%, about 60%, or greater.

The trays loaded with the collagen product dispersion product may befrozen (460). For example, the trays may be frozen from roomtemperature, e.g., about 18-23° C., to a temperature of about −20° C. toabout −60° C., or about −30° C. to about −50° C., for a duration ofabout 6 hours, for example, to achieve a uniformly frozen dispersion.This may be accomplished in any suitable manner, including by freezingthe product in a freezer or lyophilizer. In certain embodiments, whenopenings are formed (455) by pins or structures inserted into thefiltered collagen, the pins or structures may be removed (465) once thecollagen product dispersion is frozen, or the pins or structures mayremain in situ for further collagen processing.

Once frozen, the collagen product dispersion may be lyophilized (470) tomaintain the shape and distribution of the collagen product spongematrix while removing the liquid, e.g., water and alcohol, components ofthe dispersion. According to certain embodiments, a lyophilizer isprogrammed to conduct a number of cycles, each cycle having a settemperature, at a given vacuum pressure and for a given period of time.For example, the temperature inside the lyophilization chamber can be inthe range of about −70° C. to about +30° C., the vacuum pressure canrange from about 90 Millitorr to about 2000 Millitorr, and the durationfor each cycle may range from about 1 hour to about 10 hours. It will beunderstood that the cycle parameters may be selected and/or adjusted inorder to remove the water component of the collagen product dispersionwithout causing the collagen product matrix to collapse or becomedamaged. In certain implementations, when openings are formed (455) bypins or other structures inserted into the filtered collagen, the pinsor structures may be removed (475) once the collagen product dispersionis lyophilized.

In some embodiments, the lyophilized collagen product matrix may becross-linked (480) to maintain the matrix in a desired form, to impartdesirable mechanical properties of the finished matrix, and/or tocontrol the residence time of the matrix after implantation. In certainembodiments, cross-linking may be achieved by exposing the lyophilizedcollagen product matrix to a cross-linking agent. Chemical cross-linkingagents include those that contain bifunctional or multifunctionalreactive groups, and which react with functional groups on amino acidssuch as epsilon-amine functional group of lysine or hydroxy-lysine, orthe carboxyl functional groups of aspartic and glutamic acids. Byreacting with multiple functional groups on the same or differentcollagen molecules, the reacting chemical cross-linking agent forms areinforcing cross-bridge. Cross-linking agents may include:monoaldehydes, dialdehydes, polyepoxy compounds, polyvalent metallicoxides, chemicals for esterification of carboxyl groups followed byreaction with hydrazide to form activated acyl azide functionalities inthe collagen, organic tannins and other phenolic oxides derived fromplants, tanning agents, glycerol polyglycidyl ethers, polyethyleneglycol diglycidyl ethers, sugars, enzymes, heterobifunctionalcross-linking agents and transglutaminase. Particular examples of vaporphase gasses may include: formaldehyde, glutaraldehyde, acetaldehyde,polyepoxy and diepoxy glycidyl ethers, titanium dioxide, chromiumdioxide, aluminum dioxide, zirconium salt, glyoxal pyruvic aldehyde,dialdehyde starch, dicyclohexyl carbodiimide hydrazide, dicyclohexylcarbodiimide, hexamethylene diisocyanate, dicyclohexyl carbodiimide andits derivatives, hexamethylene diisocyanate, glucose, and genipin.Genipin is a naturally-occurring cross-linker, which is discussed invarious articles including: Sung H W, Chang Y, Liang I L, Chang W H,Chen Y C. Fixation of biological tissues with a naturally occurringcross-linking agent: fixation rate and effects of pH, temperature, andinitial fixative concentration. J Biomed Mater Res 2000; 52(1):77-87;Huang L L, Sung H W, Tsai C C, Huang D M. Biocompatibility study of abiological tissue fixed with a naturally occurring crosslinking reagent.J Biomed Mater Res 1998; 42(4):568-76; Tsai C C, Huang R N, Sung H W,Liang H C. In vitro evaluation of the genotoxicity of a naturallyoccurring crosslinking agent (genipin) for biologic tissue fixation. JBiomed Mater Res 2000; 52(1):58-65; Sung H W, Huang R N, Huang L L, TsaiC C, Chiu C T. Feasibility study of a natural crosslinking reagent forbiological tissue fixation. J Biomed Mater Res 1998; 42(4):560-7, eachof which are incorporate by reference in their entireties.Glutaraldehyde cross-linked biomaterials have a tendency to over-calcifyin the body. In this situation, should it be deemed necessary,calcification-controlling agents can be used with aldehyde cross-linkingagents. These calcification-controlling agents include: dimethylsulfoxide (DMSO), surfactants, diphosphonates, aminooleic acid, andmetallic ions, for example ions of iron and aluminum. The concentrationsof these calcification-controlling agents can be determined by routineexperimentation by those skilled in the art.

In certain embodiments, cross-linking may be achieved by exposing thelyophilized collagen product matrix to a cross-linking agent in the formof a vapor phase gas including gasses of one or more of the above-listedcross-linking agents. Any suitable cross-linking method may be used. Forexample, the collagen product matrix may be suspended in a vesselholding a volume of aldehyde solution sufficient to cover the bottom ofthe vessel. The vessel with the matrix suspended inside may be coveredfor a suitable period of time, e.g., a range of about 15 minutes to 2hours, to which allow the vapor phase of the aldehyde to cause vaporphase cross-linking at a suitable temperature, e.g., 18-23° C.Alternatively, the lyophilized collagen product matrix may becross-linked by dehydrothermal cross-linking, by subjecting the matrixto ultraviolet light, or by any other suitable method. Variouscross-linking methods and cross-linking agents are described in U.S.Pat. No. 6,123,731, issued on Sep. 26, 2000, entitled “Osteoimplant andMethod for its Manufacture.” In alternative embodiments, collagencross-linking may be achieved using a chemical cross-linking agent suchas a citric acid derivative. Cross-linking methods involving the use ofcitric acid derivatives and other substances are disclosed inPCT/US08/86563, filed Dec. 12, 2008, entitled “Bone/Collagen Compositesand Uses Thereof,” which is herein incorporated by reference in itsentirety for any relevant purpose. In another example, transglutaminasemay be used as a collagen cross-linking agent in order to employ milderproduct formation conditions, which may provide benefits to the finalcollagen product. For example, transglutaminase may cross-link collagenwithout damaging living cells, which may facilitate preserving naturalhuman constituents in collagen and promote growth activity. Collagenproducts, such as collagen sheets, that include living cells and/ornative human constituents such as human growth factors, which areprepared by employing collagen processing (e.g., removing the enzymetreatment steps) and product forming methods using milder conditions,may provide the final product with more active collagen containingmaterials. Alternatively, xenographic tissues substantially equivalentto human SIS, bladder, etc., may be enzymatically treated to render thetissue non-immunogenic and may be cross-linked using transglutaminase inorder to provide active collagen products.

According to certain implementations, the cross-linked collagen productmay optionally be compressed (485) to yield a collagen product with asmaller thickness compared to its pre-compression thickness. Forexample, the compressed product may be ⅔, ½, ⅓, ¼, 1/10, 1/20, 1/30,1/40, or 1/50 to 1/100 the thickness of the original product thickness.In a particular example, for a 4 mm collagen product sponge, compressingat about 125 to 175 psi, about 150 psi, or about 6,000 pounds force on a4″×5″ collagen product, for about 30 seconds yields a collagen productwith a thickness of about 0.13 mm. The compressed product may resemble apliable sheet or film having a paper-like appearance. FIG. 5B depicts acollagen product sheet formed as a result of compressing the collagenproduct sponge in FIG. 5A by force “F.” Furthermore, in someembodiments, the cross-linked collagen product may be cut to size,molded to size, or embossed in addition to or as an alternative to beingcompressed. In alternative embodiments, the matrix may be compressed andsubsequently cross-linked, which may provide a matrix that has a smallerthickness compared to a matrix that is cross-linked and compressed.

In some embodiments, the cross-linked matrix may be terminallysterilized (490) and/or virally inactivated (495). Any suitable terminalsterilization method may be used, including ethylene oxide gastreatment, cobalt radiation, gamma irradiation, electron beam radiation,gas plasma processing, etc. Sterilization and/or viral inactivationmethods are provided in Brown P., et al., Sodium hydroxidedecontamination of Creutzfeld-Jakob Disease virus, New England J. ofMed. Vol. 310, No. 11; Abe S., et al., Clinical experiences with solventdehydrated fascia lata in plastic surgery, Jap. J. Plast. Reconst. Surg.1991, Vol. 11, 721-730; and Hinton R., Jinnah R. H., Johnson C., et al.,A biomechanical analysis of solvent-dehydrated and freeze-dried humanfascia lata allografts, Am. J. Sports Med. 1992, 20: 607-612, each ofwhich are herein incorporated by reference in their entireties.

In addition to or as an alternative to sterilizing, the cross-linkedcollagen product matrix may be packaged for subsequent use as a woundrepair matrix. Packaging the collagen product may protect it fromenvironmental conditions. When the collagen product is compressed, theproduct may be sealed in an envelope or plastic bag. The compressedproduct may be prepared for use by, for example, wetting the compressedsheet-like material. In some embodiments, wetting may cause the collagenproduct to return to its original sponge-like state, for example, whencompression occurs after cross-linking. Alternatively, wetting may causethe collagen product to expand to a shape smaller than its originalsponge-like state, for example, when compression occurs beforecross-linking. The wetting process may include immersing the collagenproduct in water or spraying the collagen product with water or saline,e.g., about 0.9% saline, and may take place in a medical setting such asan operating room. Alternatively, when the collagen product is notcompressed and resembles a sponge, the product may be sealed in a trayand used in medical settings.

In further embodiments, the top, bottom and/or side surfaces of thecollagen product matrix optionally may be embossed (496) to form surfacetopography. When openings or fenestrations are formed (455) in thefiltered collagen during processing, surface embossing may converge withthe pre-formed channels arranged in the x, y, and/or z direction. Forexample, embossing a top and bottom surface of the collagen productmatrix may provide pathways to the channels to facilitate fluid movementinto the graft. Embossing may also provide for fluid management so as toavoid fluid accumulation under the graft and further may provide for theremoval of excessive wound fluid drainage. Additionally or as analternative to forming openings (455), subsequent to forming thecollagen matrix, one or more surfaces of the collagen matrix may betooled (497) to form surface fenestrations. When embossed regions arematched between two or more layers of the collagen product matrix, theycombine to provide channels in the plane of the combined collagenimplant. Such formed channels can enhance cell and fluid access into theinterior of the implant. In-plane channels may also be formed by othermeans in a single layer, including forming the collagen matrix around aseries of wires or meshes, and then removing the wires or meshes aftermanufacture.

Collagen Product Scaffolds Formed from Intermediate Collagen Products

Wound repair scaffolds produced according to the methods of FIGS. 4A and4B, U.S. patent application Ser. No. 11/673,972, and variants thereof,are depicted in FIGS. 4D-W, 5A-B, 6 (Note, the scaffold of FIG. 5A isthe same as the scaffold 601 of FIG. 6), and 14, in which the woundrepair scaffold resembles a collagen product sponge or film.

The photographs of FIGS. 4D-G depict collagen product scaffolds 4010,4020, 4030 and 4040 that are between about 3 to about 6 mm thick thatare made from human fascia in the form of an intermediate collagenproduct containing 5% ethanol that has been frozen, lyophilized andcross-linked with a suitable cross-liking agent for about an hour. Theresulting human-derived collagen product 4010 in FIG. 4D ischaracterized by crystal patterns having a narrow size distribution. InFIG. 4E, the resulting human-derived collagen product 4020 ischaracterized by a small amount of crystal sharding on the top rightside of the sample, and a near homogenous or uniform scaffold product onthe bottom left side with no crystal sharding. The photographs of FIGS.4F and 4G each show a collagen product matrix 4030, 4040 having amarbling pattern across the top surface. A marbled appearance in the endproduct is desirable because the appearance of an opaque white foam isevidence of the absence of an ice crystal pattern, an amorphous surface,and void spaces with a narrow size distribution. The collagen products4030, 4040 pictured in FIGS. 4D-G are acceptable collagen products foruse as a medical implant because the collagen products do not includequality deviations, e.g. large crystal shard borders, that may causecracking. This is due to the presence of alcohol in the frozendispersion, because by its presence the crystal nucleation and crystalsize may be controlled during freezing resulting in no or small crystalsthat are bounded. In contrast, when a collagen product does not includealcohol in the freezing and/or lyophilizing steps in the productionmethod, a thin, nearly transparent foam with frost-like patterns similarto the appearance of onion skin results, which is brittle and prone tocracking when stressed. While the above embodiments are between about 3mm and about 6 mm thick, it will be understood that collagen productscaffolds produced according to the invention may be between about 1 mmand about 12 mm thick, between about 3 mm and about 6 mm thick, or about3.5 mm thick.

The photographs of FIGS. 4H-T and the drawing of FIGS. 4U-W depictfenestrated collagen wound repair scaffolds 4050, 4055, 4060, 4065,4070, 4075, 4080, 4085, 4090, and 4095 made from human-derived collagen,including intermediate collagen products containing ethanol. Thefenestrated collagen wound repair scaffolds may have an initialthickness of about 1 mm to about 10 mm, 3 mm to about 6 mm, or about 4mm, and, when compressed and re-lofted by rehydration, may, for example,have a thickness of about 2 mm to about 5 mm for a scaffold having aninitial thickness of about 3 mm to about 6 mm. The intermediate collagenproduct used to prepare the fenestrated collagen wound repair scaffoldsmay have a collagen dispersion density of about 0.25% to about 4.0%, ofabout 0.5% to about 0.75%, or of about 0.75 to about 2.0%. The collagendispersion density may be selected based on its area of implantation orapplication in order to provide a density most appreciated by populatingcells. For example, the density of collagen may facilitate stentingwounds and managing wound closure while controlling contracture and scarformation. Where it is desirable to provide compression resistance andwound stenting, an intermediate collagen product dispersion density ofabout 4.0% may be employed. In addition, higher dispersion densities ofintermediate collagen products may provide a collagen product useful forcartilage repair grafts. In FIGS. 4H-W, the fenestrated collagen woundrepair scaffolds include fenestrations having varying sizes, from about0.56 mm to about 1.51 mm, and may extend in the x, y, and/or zdirections. The fenestrations may intersect in order to provide fluidconnections between transversely arranged channels. Providing channelsacross the wound repair scaffold enables biological fluids to movethroughout the graft while delivering cells to center areas of the graftfrom the periphery, e.g., areas generating new cellular growth, and mayprovide nutrients found in the biological fluids to promote healing andgrowth. In addition, FIGS. 4N-P and 4U-W depict fenestrated and embossedwound repair scaffolds. Embossing provides surface connections betweenthe fenestrations, which may facilitate fluid integration within thegraft, may prevent fluid accumulation under the graft and may furtherprovide for the removal of excessive wound fluid drainage.

FIGS. 4U-W depict an embodiment of a fenestrated and embossed woundrepair scaffold 4090, which includes a network of channels linearlyextending through the scaffold. Generally axial channel 4091 extendsthrough the depth of scaffold 4090, a first generally transverse channel4092 extends the width of scaffold 4090, and a second generallytransverse channel 4093 extends the length of scaffold 4090. Woundrepair scaffold 4090 further includes embossed surface channels 4094arranged on the top and bottom surfaces, which run along the width andlength of the top surfaces to form a matrix composed of a multiplicityof squares. Those of skill in the art will recognize that the surfacecan also forma multiplicity of any geometric shapes. In FIGS. 4U-W, eachof embossed channel intersection points correspond to a generally axialchannel 4091. Directly below each embossed channel extending along thewidth of the surface, at the mid-point of the depth of the wound repairscaffold, is a first generally transverse channel 4092. In addition,directly below each embossed channel extending along the length of thesurface, at the mid-point of the depth of the wound repair scaffold is asecond generally transverse channel 4093. Thus, according to FIG. 4U,the generally axial channels 4091 at the intersection points of thesurface embossed channels intersect with a first and second generallytransverse channel 4092 and 4093. However, the generally axial channelsarranged in the middle of each square formed by the matrix of surfacechannels 4094 may provide a fluid passageway through the thickness ofthe graft, but may not intersect with other channels. However, incertain embodiments another series of generally transverse channels maybe arranged within the fenestrated wound repair scaffold.

In certain specific embodiments, the orientation of a channel or aplurality of channels generally can refer to orientation of channels inwhich at least 50% of the channels are oriented in a single directionand their orientation is along a single direction of alignment, such asa generally first direction or a generally second direction. Theorientation of any given channel can deviate from the average axis ofalignment and the deviation can be expressed as the angle formed betweenthe alignment axis and orientation of the channel. A deviation angle of0° exhibits perfect alignment and 90° (or) −90° exhibits orthogonalalignment of the channel with respect to the another axis of alignment.In exemplary embodiments, the standard deviation of the generally axialchannel or a generally transverse channel from the average orientationcan be an angle selected from between 0° and 1°, between 0° and 3°,between 0° and 5°, between 0° and 10°, between 0° and 20°, or between 0°and 25°.

According to FIG. 4W, in addition to first and second generallytransverse channels 4092 and 4093, which run generally transverserelative to each other to form angles including generally 90 degreeangles at the intersection points, another set of third and fourthgenerally transverse channels 4095 and 4096 running transverse relativeto each other, but are offset by 45 degrees from the first and secondgenerally transverse channels 4092 and 4093, are provided in scaffold4090. In the embodiment of FIG. 4W, the generally axial channels 4091may intersect with third and fourth generally transverse channels 4095and 4096 in order to form a fluid connection with the periphery of thescaffold in addition to the top and bottom surfaces. Healing of woundsoccur from the wound perimeter and closure can be compromised by thesize of the wound and open area of the wound. Fenestrations can permitwound fluids to conduct cells toward centrally located open areas of thewound and sustain cells in re-growth, thereby advancing healing andclosure more quickly.

Wounds tend to heal from their perimeter and take an extensive amount oftime to close, particularly at the central location of the wound.Providing one or multiple sets of intersecting channels or fenestrationswithin the wound repair scaffold may reduce healing time by promotingcellular migration from the edges of the wound into and/or through thescaffold, thus leading cells towards the center of the scaffold, forexample. However, fenestrated wound repair scaffolds may be engineeredso that the fenestrations guide fluids and other biologics to a selectedarea or areas of the wound repair scaffold. When the wound repairscaffold is wet, the fenestrations remain open, and nutrients from thebiological fluids, along with living cells, may be distributedthroughout the graft via the fenestrations in order to establish cellformations or islands within and around the graft or selected areas ofthe graft, which facilitates wound closure. In addition, the strength ofthe wound closure decreases towards central location of the wound.Implanting a wound repair scaffolds may facilitate not only healing ingeneral, but also wound closure strength at the central portion of thewound because growth factors and nutritive materials may migrate fromthe edges of the scaffold through the open fenestrations to the centerof the graft. As a result, fenestrated wound repair scaffolds mayshorten healing time and improve wound closure thickness and strength.

According to certain implementations, fenestrated wound repair scaffoldsmay reduce scarring, improve infection control, and manage fluids.Scarring may be reduced using fenestrated wound repair scaffolds byenabling biological fluids and cells to easily permeate and traverse,e.g., via stenting, the scaffold promotes organized cellular growth.This may avoid contracture and hypertrophy by distributing biologicalfluids around and through the implant rather than constricting fluidpenetration to areas of the wound. The fenestrated wound repair scaffoldmay also promote or control infection by providing the scaffold over aportion of the wound, which may become occupied by living cells, floodedwith blood and wound repair fluids, which may promote re-establishmentof continuity at the wound site, and thus promote resistance toinfection. In addition, the channels and/or fenestrations provided inthe wound repair scaffold may have a desired strength in order tomaintain open pathways for biological fluids to pass in and through maythus manage movement of excess of biological fluids that, for example,may accumulate at the wound site in and away from the scaffold.

The fenestrated wound repair scaffold may be used in a variety ofapplications disclosed herein, and particular applications includegrafts for treating dermal wounds, pressure sores, venous stasis wounds,and diabetic ulcers. In addition, the fenestrated wound repair scaffoldsmay be used in reconstructive applications, such as for scar revisions.According to further implementations, the fenestrated wound repairscaffolds may be coated or formed with antibiotics to prevent or fightinfection, vasodilators to widen blood vessels, or angiogenic growthfactors in order to activate the formation of new blood vessels.

A collagen product scaffold 1401 made from human fascia is depicted inFIG. 14, which is a photograph, taken at 100× magnification by scanningelectron microscopy. The collagen product scaffold may be preparedaccording to the scaffold production methods described above, and may beused as a medical implant in accordance with certain embodiments of thepresent invention. The human-derived collagen product in FIG. 14 resultsfrom crystal patterns having a narrow size distribution, which resultsin a collagen product having a desirable distribution of pore size andpore density.

The sponge-like scaffold 501 of FIG. 5A results from collagen productproduction methods that do not include a compression step. In contrast,the film-like scaffold 501′ of FIG. 5B results from collagen productproduction methods that include a compression step.

It will be noted that FIG. 5B depicts a wound repair collagen productscaffold 501′ in the form of a sheet or film that may be produced inaccordance with the methods of FIG. 4A or 4B combined with a compressionstep. Compressing the collagen product after lyophilizing andcross-linking results in a flexible compressed collagen product.Compressing the collagen product after lyophilizing but beforecross-linking results in a slightly less flexible compressed collagenproduct but with stronger resistance to suture tear-out upon rewetting.Both compressed collagen products are in contrast to a bovine collagenscaffold, which is comparatively stiff or board-like.

In a further embodiment, collagen product scaffolds are preparedaccording to the embodiments described above, in which an intermediatecollagen product is lyophilized and cross-linked resulting in a collagengrafting material having a macroporous architecture with a nanofibrousmicro structure substantially throughout. FIGS. 5C(a)-(i) depict SEMimages of an engineered collagen product having an open, porous andthree-dimensional scaffold that is formed by an aligned and unorientednanofiber structure. FIGS. 5C(a)-(c) are images of the top of thecollagen product at magnifications of (a) 25×, (b) 500× and (c) 10,000×.The middle row of images, FIGS. 5C(d)-(f), are cross-sectional views ofthe product at magnifications of (d) 25×, (e) 500× and (f) 10,000×. Thebottom row of images, FIGS. 5C(g)-(i), are bottom views of the collagenproduct at magnifications of (g) 25×, (h) 500× and (i) 10,000×. Thenanofiber structure is present throughout substantially the entirescaffold. For example, FIG. 5C(c) illustrates pores lined with alignednanofibers. FIG. 5C(f) is an image of a portion of the collagencross-section having unoriented nanofibers. FIG. 5C(i) is an image of aportion of the bottom of the collagen product having both aligned andunoriented nanofibers. The image 5C(c) shows the nano fiber structure,image 5C(f) describes iso-orientation of collagen fiber bundles(precipitated) with interstice open areas and image 5C(i) describes thecollagen fiber in dense film like presentation.

FIGS. 5D(a)-(f) depict SEM images of another collagen product scaffoldbefore (FIGS. 5D(a)-(c)) and after having been compressed (4000 psi to0.004″ shims 30 s), reconstituted (0.9% saline/5 mins.) and dried(60:70:80:90:100:100% series of 200 proof alcohol/ critical point dried(e.g., supercritical CO₂)) (FIGS. 5D(d)-(f)). FIGS. 5D(a)-(c) are imagesof a profile of the collagen product before compression atmagnifications of (a) 25×, (b) 500× and (c) 10,000×. FIGS. 5D(d)-(f) areimages of the bottom of the product that has been compressed andrelofted at magnifications of (d) 25×, (e) 500× and (f) 10,000×. As canbe seen from FIGS. 5D(c)-(f), the nanofiber structure is present afterreconstitution or relofting of the collagen product, and themicrostructure is similar to that of the collagen product of FIGS.5C(a)-(i). Accordingly, reconstitution (e.g., hydration) does not leadto excessive swelling that would block pores or obstruct nanofibers.Thus, the collagen product scaffold, when implanted, may retain itsfavorable biological properties even after being pressed andreconstituted. Embodiments provided herein thus recreatethree-dimensional scaffolds having a nanofiber structure, which may helpincrease the rate of cell growth and maintain natural tissue morphology.Additionally, an open pore structure with nanofibers on the open porestructure is favorable to cell growth and supports the growth of bloodvessels into the scaffold. Images 5C(d) and (f) depict the openstructure of collagen fiber bundles that can be used to produce sheetlike form of fiber bundles depicted in image 5D(c). 5D(f) shows orientedfiber bundles that further manage the direction of cellular ingrowth.

When the collagen product sheet or film is to be used as an implant, itis removed from its packaging, if present, and may be wetted orrelofted, e.g., by wetting in saline, e.g., about 0.9% saline, so thatthe film or sheet expands into its original sponge-like shape, e.g.,into the collagen product scaffold depicted in FIG. 5A, or into asponge-like shape that may be thinner compared to its originalpre-compressed shape when the collagen product scaffold is compressedbefore, and in some embodiments after, cross-linking. The rewettedcollagen product implant is ready for implantation and may be any or allof flexible, drapeable, capable of forming a seal with adjacentstructures, strong and/or resistant to suture pullout. In addition, apressed collagen product, provided according to certain embodiments,retains a pressed flat condition when dry, whereas a bovine collagenscaffold does not. Alternatively, a collagen product scaffold may bepressed and implanted in the dried state, and may be reconstituted orrehydrated via body fluids after implantation.

A drapeable scaffold, e.g., a scaffold that is prepared by relofting,may have improved capability to conform to an implant site, e.g., thebrain. A scaffold resistant to suture pullout or tear-out provides acollagen product implant that demonstrates an ability to be suturedwithout buckling or lifting. In some implementations, where reloftingresults in an implant that is slightly thinner than the originalthickness, the collagen product may exhibit improved strength and ismore resistant to suture pullout or tear-out. A drapeable and suturablescaffold can provide a gentle, yet comprehensive seal at an implantsite.

The sponge-like or film-like wound repair scaffolds and grafts of FIGS.4D-4W and 5A-D may have various applications and may be used as adura/meningeal repair dressing, sponge-like or foam-like or otherwiseabsorbent hemostat, dermal repair dressing, cartilage repair scaffold,cell growth media, and/or substance delivery media, e.g., drugs,nutrients, growth factors, etc. Wound repair matrices may be used incombination with other medical implant structures with or withouthuman-derived or human-like collagen components. Matrices fabricatedaccording to certain implementations may be flexible, tough, soft,drape-like, have a high degree of plasticity, and/or be resistant tosuture pullout; and may be useful in applications such as neurosurgery,orthopaedic surgery, laboratory applications, dermatology, and/orplastic surgery.

Example: Comparison of Collagen Scaffolds Based on Starting CollagenMaterial

Scaffold characteristics may be at least partly dependent on the sourceof the collagen used to prepare the intermediate collagen product. Forpurposes of example, bovine tendon is compared to human tendon. Adispersion of about 0.75% bovine collagen derived from bovine tendon ismore viscous, e.g., has a thickness of honey, and results in a stiffersponge compared to a dispersion of about 0.75% human collagen derivedfrom human tendon, which is comparatively thinner (e.g., slightly moreviscous than water) and is self-leveling. In another example, bovinefascia is compared to human fascia. A dispersion of about 0.75% bovinecollagen derived from bovine fascia is a non-free-flowing highly viscousdispersion that results in a stiffer sponge compared to a dispersion ofabout 0.75% human collagen product derived from human fascia, which onthe other hand, is free-flowing (e.g., nearly water-like) andself-leveling. Each of the human-derived products has a beige color andtheir dispersions may have a yellow/green color, whereas bovinedispersions and products are relatively white. The resultinghuman-derived collagen product scaffold has a higher degree ofplasticity and elasticity compared to the bovine sponge, which allowsthe scaffold to generally return to its original shape when manipulated.Further, human-derived collagen product scaffold is flexible andresistant to cracking which allows the scaffold to be bent and twistedwithout creasing. In addition, the scaffold made from the human collagenproduct has better draping and handling properties, which allows thescaffold to be wetted and conformed and adhered to an implant area.Moreover, for human-derived collagen products made from tendon comparedto fascia, a tendon-sourced collagen product scaffold is stiffercompared to the fascia-sourced collagen product scaffold, but both aremore elastic and plastic compared to bovine-derived collagen scaffolds.Although, human-derived fascia and tendon are contemplated as a startingmaterial for producing collagen product scaffolds, intermediate collagenproducts and other collagen implants may be produced using otherhuman-derived sources, e.g., any type of human-derived collagen. It willbe appreciated, however, that bovine-sourced collagen-containing tissueand other non-human collagen-containing tissue may be used as a startingmaterial according to certain aspects of the invention, and the abovecomparison should not be construed to mean that bovine ornon-human-sourced collagen is unsuitable for embodiments of theinvention. For example, non-human tissue may be enzymatically treated toremove immunilogically active gylcoproteins and recombinant collagen,while retaining non-collagenous proteins that may provide beneficialeffects in humans. Accordingly, non-human derived tissue may beprocessed in a similar or same manner as the methods described above inorder to provide an implant that produces no or a low immunogenicresponse in humans.

Example: Comparison of Collagen Product Scaffolds Based on IntermediateCollagen Product

Collagen product scaffolds have different physical characteristics whenformed from intermediate collagen product II, III, and an intemiediatecollagen product that contains the liquid component of the blendedcollagen product dispersion, i.e., with any foam removed.

A collagen product scaffold made from intermediate collagen product II,.e.g. a reconstituted collagen product foam layer from human-derivedfascia and a leveling agent, is substantial, resists deformation andtearing when handled roughly, but is pliable. FIG. 15 is a photograph ofa collagen product scaffold 1501 produced from intermediate collagenproduct II made from human fascia as a starting material, which may beprepared for use as a medical implant in accordance with certainembodiments of the present invention.

A scaffold produced from intermediate collagen product III, .e.g.,collagen product from human-derived fascia and a leveling agent, isflexible, firm and has elastic/plastic characteristics that aresubstantially similar in both the x and y directions. However, thescaffold produced from intermediate collagen product III is not assubstantive or strong compared to the scaffold produced fromintermediate collagen product II.

A collagen product scaffold produced from a collagen product dispersionwithout a foam component, e.g., with the foam layer removed, is soft,sensitive to the touch, and easily deformable, not elastic, and tearsupon rough handling. Accordingly, the collagen scaffolds formed from thecollagen product intermediate II and III exhibits differing physical andmechanical properties.

Characterization of Collagen Scaffolds

Collagen product scaffolds produced with intermediate product III, e.g.,with the collagen dispersion and re-liquefied foam component, andsubjected to various tests for characterization.

Tensile Test: Dry collagen product scaffolds formed from human fasciawere cut into 12 mm×80 mm samples and rehydrated in 0.9% saline solutionfor 5 minutes or at least until hydrated prior to testing. Samples weresubjected to testing on a MTS® machine at a strain rate of 60 mm/min.The ultimate tensile strength for five samples, along with the averageultimate tensile strength and standard deviation are provided in Table1.

TABLE 1 Sample Ult Stress (MPa) A 5.951 B 1.708 C 2.544 D 2.208 E 1.496Average 2.782 Std. Dev. 1.819

Suture Retention Test: Collagen product scaffolds described above werecut into 10 mm×20 mm samples and rehydrated. A 4-0 Ethicon silk threadin a tf-1 tapered needle formed a suture, 3 mm suture bite 20 mm width.A MTS® machine was run at a strain rate of 20 mm/min. The suturestrength for five samples, along with the average strength and standarddeviation are provided in Table 2.

TABLE 2 Sample Strength (N) A 0.582 B 0.651 C 0.546 D 0.582 E 0.624Average 0.597 Std. Dev. 0.041

Burst Strength Test: Collagen product scaffolds described above were cutinto 100 mm×100 mm samples and rehydrated. A Mullen Burst apparatus wasattached to a MTS® machine and a constant strain rate of 305 mm/min. wasapplied (ASTM 3787). The burst strength for five samples, along with theaverage burst strength and standard deviation are provided in Table 3.

TABLE 3 Set Burst (N) @ Displacement (mm) Linear Stiffness (N/mm) A20.7130 13.9778 2.1687 31.1333 16.1899 3.0481 30.7907 13.9891 3.811225.9281 13.1448 3.3830 25.9233 15.1670 3.2199 B 34.1159 16.1587 3.222127.4880 15.1560 2.6919 22.1082 14.1627 2.2377 37.4927 16.1831 3.822439.6557 15.6670 4.0538 C 32.7945 15.3310 3.8650 25.2914 13.9613 3.225514.1775 12.1089 1.5695 25.1739 14.8091 2.9499 21.5813 14.6381 2.2134 D18.8626 13.2826 2.4716 32.4219 16.1484 3.2478 20.4316 14.2975 2.022725.1739 14.9851 2.6338 26.8084 13.6325 3.1078 Average 26.9033 14.64952.9483 Std. Dev.  6.4641  1.1414 0.6849

Denaturation Temperature Test: Collagen product scaffolds describedabove were cut into 4 mm×4 mrn samples and rehydrated for 15 minutes.The samples were placed in an aluminum crucible, sealed and run in a DSCanalysis at a temperature increase of 10° C./min. The temperature awhich each of the nine samples denatured, along with the averagetemperature and standard deviation are listed in Table 4.

TABLE 4 Sample Temperature (° C.) A 63.0 B 62.3 C 61.5 D 56.7 E 56.8 F58.2 G 61.0 H 56.8 I 56.8 J 58.9 K 56.7 L 58.1 Avg. ± Std. 58.9 ± 2.4

Visual Characterization: Lyophilized collagen product scaffolds producedaccording to certain embodiments of the present invention were comparedto other collagen product scaffolds using stereology. FIG. 16 is aphotograph with grid overlay of a 13 cm×10 cm collagen product scaffoldproduced according to known methods. The typical ice sharding patternviewable in the collagen product scaffold 1601 of FIG. 16 produces largeshards spanning areas over several square centimeters. FIG. 17 is aphotograph of a collagen product scaffold 1701 with grid overlay of a 15cm×11 cm collagen product scaffold produced according to embodiments ofthe present invention. According to FIG. 17, the ice sharding patternsare comparatively small. FIGS. 18A-B are 3 cm×3 cm areas of the scaffold1601 of FIG. 16 showing an example large shard outlined by 3 arrows,which spans an area that is approximately 70 mm². FIG. 18B provides aclear image of the large shard with the small grid lines removed. Incomparison, FIGS. 19A-B are 3 cm×3 cm areas of the scaffold 1701 of FIG.17 where each shard is approximately 11 mm². FIG. 19B provides a clearimage of the small shards with the small grid lines removed. In view ofFIGS. 16-19, lyophilized collagen product scaffolds 1701 producedaccording to some implementations of the present invention arecharacterized by small shards when compared to lyophilized collagenproduct scaffolds 1601 produced by other means. It is believed thatsmall shard patterning provides a stronger, more durable collagenproduct scaffold and that large shard patterning results in a weaker,less durable collagen product scaffold. Accordingly, collagen products,in particular lyophilized scaffolds, produced according toimplementations of the present invention are high strength, durable andbiologically compatible collagen product implants. In someimplementations (not shown), collagen product scaffolds may be producedaccording to embodiments of the invention that further include theaddition of glycerol to the collagen product suspension, which mayaffect the crystal size of the finished scaffold.

Scanning Electron Microscope (SEM) Characterization: Lyophilizedcollagen product scaffolds produced according to certain embodimentswere compressed at 3000 lbs, reconstituted and dried. SEM images of thelyophilized scaffolds 2001 show pore structure on a first surface of thescaffold, e.g., top surface, at a magnification of 50× (FIG. 20A), 100×(FIG. 20B), 250× (FIG. 20C) and 500× (FIG. 20D). SEM images of anotherlyophilized collagen product scaffold 2101 shows the scaffold structureof another surface of the scaffold, e.g., bottom surface or the scaffoldsurface that is directly adjacent to the surface it was frozen upon, ata magnification of 25× (FIG. 21A), 50× (FIG. 21B), 100× (FIG. 21C) and250× (FIG. 21D). From FIGS. 20A-D, the pore structure of the collagenproduct scaffold 2001 is relatively uniform. Uniformity in porestructure may provide a substantial and pliable implant that resistsdeformation and tearing when handled roughly.

Collagen Product Matrix/Sling

In further embodiments, the matrix or scaffold produced according to themethods depicted in FIGS. 4A, 4B, U.S. patent application Ser. No.11/673,972, and variants thereof, may be further processed to alter oradd material to the scaffold. For example, according to FIG. 4C, theliquid component is removed to form a matrix from FIG. 4A, and one ormore cross-linking cycles (4005, 4006) may be added to the productionprocess that will increase the density of the scaffold.

In addition or alternatively, and according to FIG. 4C, the scaffold maybe reinforced (4007) by adding to the scaffold PEEK film, polylactideand polypropylene sutures, bone, metal implants (e.g., steel), anynumber of bio active polymers, e.g., tyrosine polycarbonates andtyrosine polyarylates, bio active drugs in poly form, and/or otherbiocompatible materials. Processes for adding reinforcing materials tothe matrix may include: lamination, vapor deposition, dispersion, and/orchemical reaction. In addition, the altered collagen product matrix orscaffold may be compressed. Moreover, collagen products may be alteredby providing one or more of the above-mentioned materials inside of thecollagen product matrix. For example, PEEK film may be provided as amesh or other reinforcing component and the collagen product matrix maybe formed over and around the mesh.

Altered collagen product matrices described above may be used as arepair matrix or sling in applications such as rotator cuff repair,breast reconstruction or augmentation, hernia repair, vaginal wallrepair, sphincter repair, meniscus repair, and/or annular repair of thespine. Accordingly, the altered collagen product may be useful ingeneral, orthopaedic, obstetric, gynecological, plastic, and/orurological surgical settings, for example.

Although the intermediate collagen products I-III may be producedaccording to the above-described methods in which isolated collagenfiber and/or thread base materials are used to produce the intermediatecollagen product, e.g., previously recovered dried and dehydratedcollagen, intermediate collagen products I-III produced during thecollagen recovery process are also contemplated. For example, collagenrecovery methods including the methods described in the above-mentionedpatent application Ser. No. 11/673,972, filed Feb. 12, 2007, entitled“Methods for Collagen Processing and Products using Processed Collagen,”may include a processing step in which a leveling agent, e.g., alcoholor a salt, is blended with the collagen so that the collagen issuspended in a foam and liquid layer. The foam may be recovered and thecollagen product therein further processed according various collagenrecovery steps in order to prepare collagen and produce intermediatecollagen products II and/or III.

Furthermore, intermediate collagen production methods and collagenimplant production methods described above may include some or all ofthe steps in any order. For example, an intermediate collagen productmay include the liquid component of the blended collagen dispersioncontaining a leveling agent and not the foam component. Such anintermediate product may be useful when preparing composite collagenproducts, for example, that have a collagen product made from only thecollagen foam, and a collagen product made only from the collagendispersion left after the foam is removed. Moreover, although theproducts described above have associated exemplary applications, otherapplications for the products are also contemplated. For example, woundrepair matrices resembling a sponge or a film may serve as a growthmedia or substrate (e.g., stem cell growth media).

The above-described structural implants and method of making theimplants that include human-derived or human-like collagen productsshould not be construed as limiting. For example, additional collagentypes may be used in addition to or as an alternative to human-derivedcollagen. In some embodiments, collagen products may be prepared fromgenetically modified animals in a manner that renders the collagenproducts non-immunogenic, or that renders collagen products having smallamounts of antigenic components. In a particular example, collagenproducts derived from genetically modified pigs, which have nofunctional expression of the alpha 1,3 galactosyl transferase gene, maybe used as a source of collagen. Furthermore, collagen products may berecovered from bovine, goat, sheep, or any animal genetically modifiedfor use in humans. In another example, animal collagen products thathave been enzymatically treated to remove glycoproteins to make thecollagen substantially similar to human collagen may be used inaccordance with some embodiments. In another example a substantiallynon-immunogenic collagen-containing soft tissue xenograft may be used asa starting material, and is disclosed in U.S. Pat. No. 6,455,309, issuedSep. 24, 2002, entitled “Proteoglycan-reduced soft tissue xenografts,”which is incorporated by reference herein in its entirety. Collagen mayalso be grown in cell cultures (e.g., recombinant collagen), which maybe engineered to possess human or human-like characteristics. In afurther example, xenograft placenta may comprise a source of collagen,which may be used as a collagen product implant alone or in combinationwith collagen derived from humans, e.g., human placenta. Collagen fiberand/or thread base materials sourced from human collagen-containingtissue or human-like or from the above-described genetically modified orotherwise treated collagen used to form the products described arebelieved to be less likely to produce an immunogenic response when usedfor implantation into humans, and thus are likely to be accepted at animplant site.

The above-described structural implants should not be construed aslimiting. For example, according to certain embodiments, variousproducts having human-derived or human-like collagen product fiberand/or thread base materials may be combined to form a composite of twoor more of the above-mentioned products. In one example, a collagenproduct thread may be combined with a collagen product scaffold/matrix,each which may be produced using the same or a different inteiniediatecollagen product as a starting material. In another example, collagenfilms may be combined with a collagen product scaffold/matrix byincorporating the film into and/or on the collagen productscaffold/matrix. In a further example, collagen product fibers, threads,fibrils and/or particles may be combined with each other, or may becombined with a collagen film, scaffold, etc. Other products not havinghuman-derived or human-like collagen product fiber and/or thread basematerials may also be combined with the various products describedherein. Moreover, although the products described above have associatedexemplary applications, other applications for the products are alsocontemplated. For example, wound repair scaffolds resembling a sponge ora collagen product film may serve as a growth media or substrate. Inaddition, medical implants having human-derived or human-like collagenfiber and/or thread base materials may be formed as a flexible or rigidimplant depending on the implant's intended application.

Furthermore, products incorporating human-derived or human-like collagenfiber and/or thread base materials may be designed to include variousphysical characteristics. For example, structural repair implants havingincorporated collagen product fiber and/or thread base materials may beconstructed so that the implant is suturable, e.g., where the patch isproduced to include suture holes in the non-woven fabric 701 seen inFIG. 7, such that the implant can be fixed at an implant site. Inaddition, medical implants incorporating human-derived or human-likecollagen product fiber and/or thread base materials may be formed as aflexible or rigid implant depending on the implant's intendedapplication. In another example, human-derived or human-like collagenproducts may be mixed with synthetic collagen or other syntheticbiocompatible substances in order to achieve a desired product, physicalproperty or performance. In a particular example, a synthetic, collagenproduct, or synthetic/collagen product fabric and/or scaffold may beincorporated with a collagen product scaffold, which may be implanted orcompressed to yield a low profile material suitable for implantation. Inanother example, a collagen product is mixed with elastin from anysource, or from humans, bovine, and/or porcine sources to yield productshaving particular strength characteristics. In addition, human-derivedor human-like collagen products may be processed into putties or pastesso that the implant may be melted and/or shaped for an appropriateimplantation use.

In accordance with some embodiments, other additives, including but notlimited to those described below, may be added as a supplement to thehuman collagen products. It will be appreciated that the amount ofadditive used will vary depending upon the type of additive, thespecific activity of the particular additive preparation employed, andthe intended use of the composition. Any of a variety of medicallyand/or surgically useful optional substances can be added to, orassociated with, the collagen product material, at any appropriate stageof the processing.

For example, angiogenesis may be an important contributing factor forthe collagen product device in certain applications. In certainembodiments, angiogenesis is promoted so that blood vessels are formedat an implant site to allow efficient transport of oxygen and othernutrients and growth factors to the developing bone or cartilage tissue.Thus, angiogenesis promoting factors may be added to the collagenproduct to increase angiogenesis. For example, class 3 semaphorins,e.g., SEMA3, controls vascular morphogenesis by inhibiting integrinfunction in the vascular system, Serini et al., Nature, (July 2003)424:391-397, and may be included in the collagen product device.

In accordance with other embodiments, collagen product devices may besupplemented, further treated, or chemically modified with one or morebioactive agents or bioactive compounds. Bioactive agent or bioactivecompound, as used herein, refers to a compound or entity that alters,inhibits, activates, or otherwise affects biological or chemical events.For example, bioactive agents may include, but are not limited to,osteogenic or chondrogenic proteins or peptides; demineralized bonepowder as described in U.S. Pat. No. 5,073,373; hydroxyapatite and/orother minerals; xenogenic collagen products, insoluble collagen productderivatives, etc., and soluble solids and/or liquids dissolved therein;anti-AIDS substances; anti-cancer substances; antimicrobials and/orantibiotics such as erythromycin, bacitracin, neomycin, penicillin,polymycin B, tetracyclines, biomycin, chloromycetin, and streptomycins,cefazolin, ampicillin, azactam, tobramycin, clindamycin and gentamycin,etc.; immunosuppressants; anti-viral substances such as substanceseffective against hepatitis; enzyme inhibitors; hormones; neurotoxins;opioids; hypnotics; anti-histamines; lubricants; tranquilizers;anti-convulsants; muscle relaxants and anti-Parkinson substances;anti-spasmodics and muscle contractants including channel blockers;miotics and anti-cholinergics; anti-glaucoma compounds; anti-parasiteand/or anti-protozoal compounds; modulators of cell-extracellular matrixinteractions including cell growth inhibitors and antiadhesionmolecules; vasodilating agents; inhibitors of DNA, RNA, or proteinsynthesis; anti-hypertensives; analgesics; anti-pyretics; steroidal andnon-steroidal anti-inflammatory agents; anti-angiogenic factors;angiogenic factors and polymeric carriers containing such factors;anti-secretory factors; anticoagulants and/or antithrombotic agents;local anesthetics; ophthalmics; prostaglandins; anti-depressants;anti-psychotic substances; anti-emetics; imaging agents;biocidal/biostatic sugars such as dextran, glucose, etc.; amino acids;peptides; vitamins; inorganic elements; co-factors for proteinsynthesis; endocrine tissue or tissue fragments; synthesizers; enzymessuch as alkaline phosphatase, collagenase, peptidases, oxidases, etc.;polymer cell scaffolds with parenchymal cells; collagen lattices;antigenic agents; cytoskeletal agents; cartilage fragments; living cellssuch as chondrocytes, bone marrow cells, mesenchymal stem cells; naturalextracts; genetically engineered living cells or otherwise modifiedliving cells; expanded or cultured cells; DNA delivered by plasmid,viral vectors, or other means; tissue transplants; autogenous tissuessuch as blood, serum, soft tissue, bone marrow, etc.; bioadhesives;BMPs; osteoinductive factor (IFO); fibronectin (FN); endothelial cellgrowth factor (ECGF); vascular endothelial growth factor (VEGF);cementum attachment extracts (CAE); ketanserin; human growth hormone(HGH); animal growth hormones; epidermal growth factor (EGF);interleukins, e.g., interleukin-1 (IL-1), interleukin-2 (IL-2); humanalpha thrombin; transforming growth factor (TGF-beta); insulin-likegrowth factors (IGF-1, IGF-2); parathyroid hormone (PTH); plateletderived growth factors (PDGF); fibroblast growth factors (FGF, BFGF,etc.); periodontal ligament chemotactic factor (PDLGF); enamel matrixproteins; growth and differentiation factors (GDF); hedgehog family ofproteins; protein receptor molecules; small peptides derived from growthfactors above; bone promoters; cytokines; somatotropin; bone digesters;antitumor agents; cellular attractants and attachment agents;immuno-suppressants; permeation enhancers, e.g., fatty acid esters suchas laureate, myristate and stearate monoesters of polyethylene glycol,enamine derivatives, alpha-keto aldehydes, etc.; and nucleic acids.

In certain embodiments, the bioactive agent may be a drug. In someembodiments, the bioactive agent may be a growth factor, cytokine,extracellular matrix molecule, or a fragment or derivative thereof, forexample, a cell attachment sequence such as RGD. A more complete listingof bioactive agents and specific drugs suitable for use in the presentinvention may be found in “Pharmaceutical Substances: Syntheses,Patents, Applications” by Axel Kleemann and Jurgen Engel, Thieme MedicalPublishing, 1999; the “Merck Index: An Encyclopedia of Chemicals, Drugs,and Biologicals”, Edited by Susan Budavari et al., CRC Press, 1996; andthe United States Pharmacopeia-25/National Formulary-20, published bythe United States Pharmcopeial Convention, Inc., Rockville Md., 2001.

In some embodiments, the agent to be delivered may be adsorbed to orotherwise associated with the human collagen. The agent may beassociated with the collagen product through specific or non-specificinteractions, covalent or non-covalent interactions, etc. Examples ofspecific interactions include those between a ligand and a receptor, anepitope and an antibody, etc. Examples of non-specific interactionsinclude hydrophobic interactions, electrostatic interactions, magneticinteractions, dipole interactions, van der Waals interactions, hydrogenbonding, etc. In certain embodiments, the agent may be attached to thecollagen product using a linker so that the agent is free to associatewith its receptor or site of action in vivo. In other embodiments, theagent may be bound or captured within the collagen product as a resultof collagen cross-linking. In certain embodiments, the agent to bedelivered may be attached to a chemical compound such as a peptide. Inanother embodiment, the agent to be delivered may be attached to anantibody, or fragment thereof, that recognizes an epitope found withinthe collagen. In certain embodiments, at least two bioactive agents maybe attached to the collagen product. In other embodiments, at leastthree bioactive agents may be attached to the collagen product. Sebaldet al., PCT/EP00/00637, describes the production of exemplary engineeredgrowth factors that are beneficial for use with the collagen device.

While the present disclosure is written primarily in terms of humantissue and human collagen, it is understood that some methods may beused in any appropriate context with any appropriate material. Thepresent invention is directed to any type of tissue that may beimplanted in an allogenic context in any vertebrate species. Forexample, equine collagen may be processed and used for equineimplantation, canine collagen may be processed and used for canineimplantation, etc. The use of tissue for implantation from the samespecies source can provide benefits due to the potential of the naturalconstituents, unique to the species, providing implantation benefitsonce implanted. For example, a biochemical response in the implanteerecognizing the natural constituents in the implant as acceptable mayfacilitate biological processes such as cross-linking and integration.

The above description should not be construed as limiting, but merely asexemplifications of, preferred embodiments. Those skilled in the artwill envision other modifications within the scope and spirit of thepresent disclosure.

1. A fenestrated wound repair scaffold comprising human collagen or human collagen products, said fenestrated wound repair scaffold comprising a plurality of openings in the scaffold to provide for movement of biological materials through the openings and into the scaffold.
 2. The fenestrated wound repair scaffold of claim 1, wherein the series of the plurality of openings comprises a first plurality of channels generally oriented in a first direction and a second plurality of generally oriented in a second direction generally perpendicular to the first plurality of channels.
 3. The fenestrated wound repair scaffold of claim 2, wherein at least a portion of the first and second plurality of channels are generally fluidly connected.
 4. The fenestrated wound repair scaffold of claim 2, wherein the second plurality of channels comprises a first set of channels and a second set of channels arranged generally transverse to the first set of channels.
 5. The fenestrated wound repair scaffold of claim 4, wherein first set of channels and the second set of channels are generally fluidly connected.
 6. The fenestrated wound repair scaffold of claim 1, further comprising a series of surface channels arranged along a length and a width of a top surface and a bottom surface of the fenestrated wound repair scaffold.
 7. The fenestrated wound repair scaffold of claim 6, wherein a portion of the surface channels arranged along the length and the width intersect and form a matrix of geometric shapes, and a channel extends through a thickness of the fenestrated wound repair scaffold.
 8. The fenestrated wound repair scaffold of claim 7, wherein the thickness is about 2 mm to about 3 mm.
 9. The fenestrated wound repair scaffold of claim 1, wherein a ratio of the openings arranged in the scaffold is between about 10% and about 30%.
 10. The fenestrated wound repair scaffold of claim 1, wherein said plurality of openings promote wound closure strength.
 11. A fenestrated wound repair scaffold comprising enzymatically-treated human-derived collagen having a preserved amount of its natural collagen constituents, wherein the fenestrated wound repair scaffold comprises a network of openings passing generally linearly through the wound repair scaffold to form channels configured for cells to pass into, said network of openings promoting the formation of a series of cell formations within the fenestrated wound repair scaffold.
 12. The fenestrated wound repair scaffold of claim 11, whereby the network of openings further promote wound closure strength.
 13. The fenestrated wound repair scaffold of claim 11, wherein said scaffold comprises a graft for treating dermal wounds.
 14. The fenestrated wound repair scaffold of claim 11, wherein said scaffold comprises a graft for treating pressure sores.
 15. The fenestrated wound repair scaffold of claim 11, wherein said scaffold comprises a graft for treating venous stasis wounds.
 16. The fenestrated wound repair scaffold of claim 11, wherein said scaffold comprises a graft for treating diabetic ulcers.
 17. The fenestrated wound repair scaffold of claim 11, wherein said scaffold comprises a graft for reconstructive applications.
 18. A method for forming a fenestrated wound repair scaffold, comprising: dispersing in solution an enzymatically-treated human derived collagen product having a preserved amount of its natural constituents; depositing the dispersed collagen product in a tray; forming a plurality of openings in the solid portion of the dispersed collagen product; and removing the liquid component of the dispersed collagen product.
 19. The method of claim 18, wherein forming the plurality of openings in the dispersed collagen product comprises inserting a plurality of pins of a selected cross-section into the dispersed collagen product.
 20. The method of claim 19, wherein the plurality of pins includes pins inserted in more than one direction.
 21. The method of claim 19, further comprising removing the plurality of pins.
 22. The method of claim 18, wherein dispersing in solution the collagen product comprises dispersing a collagen product having a dispersion density of about 0.25% to about 2.0%.
 23. The method of claim 18, further comprising embossing at least one outer surface of the fenestrated wound repair scaffold.
 24. The method of claim 18, further comprising contacting the collagen dispersion of the fenestrated wound repair scaffold with antibiotic materials, vasodialators or angiogenic growth factors.
 25. A wound repair scaffold comprising enzymatically-treated human derived collagen having a macroporous architecture with a nanofibrous collagen micro structure favorable for cell growth and supporting the growth of blood vessels into the scaffold.
 26. The would repair scaffold of claim 25, wherein the nanofibrous micro structure comprises a plurality of aligned collagen nanofibers.
 27. The would repair scaffold of claim 25, wherein the wound repair scaffold comprises a matrix of reticulated pores configured to allow movement of cells and fluid in and along the length of the strand.
 28. The would repair scaffold of claim 27, wherein a plurality of reticulated pores are lined with collagen nanofibers. 